To our knowledge, this is the first study assessing the impact of a clinic pharmacist on MG management and adds to the literature evaluating the impact of a clinic pharmacist in MS management. Evaluating monitoring parameters accounted for most of the interventions made by the clinical pharmacist. Treatments for MS and MG involve medications with specific monitoring parameters. For example, interferon beta-1a is a medication made from of the endogenous interferons in the human body. This therapy carries the risk of hepatic injury, pancytopenia, and thrombocytopenia. Therefore, monitoring complete blood and differential white blood cell counts, platelet counts, and liver function tests are recommended during therapy [8]. Similarly for MG, immunosuppressive regimens used for treatment, such as prednisone, azathioprine, and mycophenolate require monitoring of blood counts, liver function, and blood glucose, among others [9]. Our study shows how the pharmacist can play a vital role in optimizing care by ensuring appropriate monitoring parameters are obtained and documented for treatment.
In our study, the pharmacist identified six different types of discrepancies in the majority of patients while performing medication reconciliation, with the most common being the removal of a medication from a list. Other common interventions included adding a medication to or correcting a medication’s dose in the patient’s medication list in the EMR. These identified discrepancies prevent potentially harmful adverse events that could occur at any level of the health care system. The Institute of Medicine states that at least 1.5 million preventable adverse drug events occur per year, costing more than $4 billion annually. Studies have shown that pharmacists provide a more robust medication reconciliation and minimize the number of errors and discrepancies found in a patient’s medication list compared to other health care providers [10]. A study comparing the impact of pharmacist versus nurse-obtained medication histories was conducted that showed more discrepancies were identified by a pharmacist and a higher percentage of patients received a clinical intervention (p< 0.001) [11].
In addition to direct patient care activity, the clinical pharmacist had an impact on patient care through indirect services, showing the range of services a pharmacist can provide. The services do not include only medication reconciliation. Telephone encounters and patient messages via the EMR were documented at a large frequency, representing the volume of counseling on medications, managing adverse drug reactions, and navigating medication access issues the pharmacist can complete. The pharmaceutical knowledge that a pharmacist can provide helps to optimize patient care by improving patients’ understanding of their regimen while providing financial support.
There are several limitations of this study. The retrospective design of the study makes data extraction reliant on complete and accurate documentation of pharmacist encounters and services in the EMR. Secondly, the data regarding indirect services was obtained by the institution’s data analytics team. The method used to pull the data is unclear and at the time of this writing is current under review for redesign of the report, so the data received may not be completely representative of the services performed. It is important to note that, in our study, only one CPP was serving the entire neurology clinic. Thus, there are some MG and MS patients that the CPP may not be able to see due to time constraints. Additionally, our study only assessed direct patient care activity for MS and MG patients. The impact a pharmacist can have on other neuromuscular and neurological diseases was not captured.
Another limitation is that pharmacist involvement in medication access could not be included in the study. The method to obtain the number of medication access referrals was unable to limit the number to our specified timeframe. Finally, a portion of our study captured data that occurred during the coronavirus pandemic, which was from the middle of March until the beginning of June 2020. During this time, there was a decrease in indirect and direct services provided.
This study shows the services a clinical pharmacist can provide in a specialty clinic setting, which supports the role of including a pharmacist in the interdisciplinary team. The addition of a pharmacist can enhance patient care through medication assessment and counseling as well as navigation of medication access issues. Further research is needed to determine the financial implications and benefits of the addition of a pharmacist and to assess provider and team satisfaction of this addition.