Improving Safety in Rheumatology Patients by Closing Pre-screening Laboratory Care Gaps with Rheumatologist-Pharmacist Co-management

Abstract

Objective: To close laboratory screening care gaps via rheumatology-pharmacy co-management in patients starting disease-modifying antirheumatic drugs.

Methods: Laboratory data were obtained from patients who started disease-modifying antirheumatic drugs (DMARDs) during the pre-and post-intervention periods. The intervention consisted of a rheumatology-pharmacy collaborative screening with guideline-driven DMARD protocol for hepatitis B, hepatitis C, and tuberculosis. The care gap closure for patients starting any type of DMARDs such as a conventional synthetic disease-modifying antirheumatic drug (csDMARD), a biologic disease-modifying antirheumatic drug (bDMARD), or a targeted synthetic disease-modifying antirheumatic drug (tsDMARD), was defined as meeting hepatitis screening completion. The care gap closure for patients starting a bDMARD or tsDMARD alone was defined as meeting both the hepatitis and tuberculosis screening completion. The Chi square method was used for the statistical analysis of the data comparing laboratory screening rates of rheumatologists’ pre-intervention versus rheumatologist-pharmacist co-management post-intervention. Post-intervention, subgroup analysis of laboratory screening rates among rheumatologists alone versus rheumatologist-pharmacist co-management was also performed.

Results: During the 30-month period 6/1/2019 to 11/30/2021, hepatitis screening for patients on DMARDs improved from 77% with rheumatologists alone to 82% with co-management post-intervention (P=0.005), whereas hepatitis/tuberculosis screening for patients on bDMARDs/tsDMARDs improved from 75% to 85% respectively (P=0.005). In post-intervention subgroup analysis, hepatitis screening for patients on DMARDs improved from 80% with rheumatologists alone to 95% with co-management(P=0.00), whereas hepatitis/tuberculosis screening for patients on bDMARDs/tsDMARDs improved from 83% to 94% respectively (P=0.033).

Conclusion: By integrating clinical pharmacists into our rheumatology clinic, we significantly improved hepatitis and tuberculosis laboratory screening in our immunosuppressed rheumatic population.

Implications: Rheumatologists can consider integrating clinical pharmacists into their practices to improve patient safety by closing laboratory screening care gaps in the immunosuppressed rheumatic population.