In-Office Pharmacist Improves Patient Care

A large rheumatology practice is reaping many benefits from having a pharmacy presence onsite. After learning that a nearby endocrinology practice had a successful arrangement with a local pharmacy school to provide pharmacy services, Lee Shapiro, MD, a rheumatologist at The Center for Rheumatology (TCFR), based in Albany, N.Y., became eager to partner with the school in 2005.

The arrangement works by having Jessica Farrell, PharmD, a clinical pharmacist and associate professor of pharmacy practice at Albany College of Pharmacy and Health Sciences (ACPHS), provide clinical pharmacy services at TCFR. In exchange, TCFR serves as an experiential education practice site for pharmacy students in their final year of school. Dr. Farrell, who joined the practice in 2008, precepts two to three students who work within the practice on six-week rotations. She splits her time between TCFR and ACPHS.

A key benefit Dr. Farrell and her students provide to the practice, according to Dr. Shapiro, is enhanced patient education.

Lee Shapiro, MD

“During office visits, physicians have minimal time to provide a lot of information regarding a medication, other than dosing instructions,” Dr. Shapiro says. “Most patient education on medication occurs at a community pharmacy, but that is not always the case for specialty medications, such as Humira [adalimumab] and Enbrel [etanercept], which are often mailed directly to a patient’s home.”

Because Dr. Farrell and her students have access to TCFR’s electronic health records system, they can review a patient’s diagnosis, laboratory results and other patient details, such as comorbidities, allowing them to provide tailored and individualized medication recommendations for each patient.

Additionally, the pharmacy team has more time to discuss side effects, the best time of the day to take a medication and so forth. “Patients leave feeling better informed and less anxious about taking a medication, which increases compliance,” says Dr. Shapiro, who adds that he believes a pharmacist may have better knowledge than a rheumatologist regarding drug interactions and timing of the dosing to maximize absorption and minimize interactions.

Another benefit stems from the fact that many rheumatic diseases have few or no FDA-approved medications, resulting in rheumatologists often prescribing medications off-label, including biologics. “It’s very laborious for a rheumatologist to review the literature, gather the evidence and make a case to convince an insurance company’s medical director to approve an off-label use,” Dr. Shapiro says.

Consequently, Dr. Farrell has created a letter library for certain rheumatic conditions that can benefit from the off-label use of a specific medication. “Then, the rheumatologist simply has to personalize the letter with an opening statement explaining the patient’s circumstances, what treatments they have tried and why there is a need for additional therapy,” Dr. Shapiro says.