Delivering Evidence-based Care by Comanaging Headache Patients with a Primary Care Clinical Pharmacist
Adriene Zook1, Apoorva Pradhan2, Leeann Webster1, Michael Kachmarsky1, Eric Wright2, Scott Friedenberg3
1Medical Therapy Disease Management, 2Pharmacy Innovation, Geisinger, 3Geisinger Medical Center
Objective:
We propose to test the viability of primary care clinical pharmacists in delivering evidence-based migraine care.
Background:
Clinical pharmacists routinely provide collaborative comanagment for chronic diseases like diabetes. Our headache patients may be prime candidates for pharmacy comanagement as 15% of our headache referrals have primary headaches and have tried only trialed one or no medications.
Design/Methods:
Primary care clinical pharmacists at Geisinger were trained to manage migraine and assess headache burden. Knowledge of this service was disseminated by word of mouth, education seminars and electronic prompting. Primary care providers referred patients with a diagnosis of migraine. Pharmacists confirmed the clinical history, assessed baseline disease burden, provided education, and followed a preventative and acute treatment algorithm. Pharmacists collaborated with primary care physicians or neurologists on an as needed basis. A descriptive analysis was undertaken to assess the pharmacist's prescribing habits and patient reported headache burden.
Results:
One hundred and three patients (91 females, 12 males, average age (SD): 38 (13) years) were seen over 18 months with 60 having follow up appointments. Supplements were recommended 26 times, and 76 prescriptions were written for evidence based preventative medications including 23 for CGRPI’s. Pharmacists prescribed evidence based acute therapies 70 times including 17 for Gepants. Antiemetics were prescribed for seven patients. Ninety-four patients had a baseline of sixteen headache days per month, fifty (53%) surveyed at follow up had an average of seven headache days per month with forty of them (80%) reporting fewer headache days than their baseline. Nine patients had a subsequent neurology consultation and three had an ER visit.
Conclusions:
Incorporating a clinical pharmacist in headache care creates an avenue for improved medication management. Next steps include expanding the adoption of these services withing our healthcare system and an in-depth analysis.