Objective:

To examine the role of an integrated outpatient specialty neurology pharmacist in the non-multiple sclerosis setting.

Background:

Patient and provider benefits have been demonstrated by integrating pharmacists in multiple sclerosis clinics, but research evaluating pharmacist interventions within outpatient neurology clinics is needed.

Design/Methods:

A single-center, retrospective cohort study conducted from January to March 2023 enrolled all patients prescribed a specialty medication from the non-multiple sclerosis neurology clinics with at least one intervention. Outcomes included number and type of interventions, prescriber recommendation acceptance rate, intervention impact scores (1 to 4 based on severity of consequence without the intervention), intervention outcomes, cost savings, and time required to complete interventions. An ordinal mixed effects regression model analyzed factors associated with greater intervention times. 

Results:

The study included 741 patients: median age 60 (Interquartile range [IQR] 22-72) years, 83% White, 55% Male, and 69% utilized the integrated health-system specialty pharmacy (HSSP) for medication fulfillment. Pharmacists performed 2,244 interventions, generating 392 recommendations with a 98% acceptance rate. The most common impact score was 2 (76% - quality of life impacted) and a median of 10 (IQR 5-15) minutes were required per intervention. Of the 56 interventions related to follow-up on a medication titration or dose change, 32 interventions led to further recommendations. Overall, 214 recommendations were made. Recommendations commonly led to medication changes (128, 60%), financial assistance referrals (64, 30%), and safety monitoring (22, 10%). Cost savings totaled $188,570 (average wholesale price minus 20%) by recommendations leading to medication therapy changes. Factors associated with longer intervention times included integrated HSSP utilization, clinic specialty, insurance type, and pharmacist interventions (compared to quick actions).

Conclusions:

Integrated outpatient specialty neurology pharmacists in non-multiple sclerosis neurology clinical settings perform a high number of interventions often leading to medication therapy changes, medication monitoring, and cost savings.