Specialty pharmacy disease screening and routine assessments for patients with rheumatoid arthritis and psoriasis
Authors: Dube Alana J. , McCall Kenneth L. , Stickney Kirsten E. , Gelinas Alycia 
Published: June 2022

Background

Rheumatoid arthritis and psoriasis are inflammatory diseases which require frequent monitoring to optimize therapy. Specialty pharmacists are in the unique position to assist in the screening and monitoring of patients with complex, chronic diseases.

Objectives

The study objective is to describe the impact of pharmacist screening services in two patient populations. In patients with rheumatoid arthritis, the goal is to describe outcome monitoring through disease severity, therapeutic switches, and adherence rates. In patients with psoriasis, the aim is to describe the utilization of a screening for psoriatic arthritis and the resulting number of potential referrals to medical providers.

Methods

The retrospective study patient population consisted of rheumatoid arthritis (RA) patients who filled one or more prescriptions at a specialty pharmacy between 8/22/2017 and 9/26/2018, and psoriasis patients who filled between 6/1/2021 to 9/1/2021. A Routine Assessment of Patient Index Data 3 (RAPID3) score was collected during a refill coordination call every three months throughout the 13-month period for RA patients, and a Psoriasis Epidemiology Screening Tool (PEST) scores reported throughout the stated timeline.1,2 Data was imported from the pharmacy’s electronic medical record into an Excel spreadsheet with each row representing a unique patient. Following data validation, descriptive statistics including means, standard deviations, and percentages were calculated to characterize the sample. Statistical significance was determined at an alpha of 0.05.

Results

Of the patients who had 4 assessments for RAPID3, the disease severity category significantly improved from assessment 1 to assessment 4 (p=0.021) when analyzed using a chi-square test. The RAPID3 assessment of patients with RA by pharmacists in a specialty setting identified responders (n=21, 25.6%) and stable patients (n=51, 63%), which reinforces current therapy, and non-responders (n=10, 12.2%), who may benefit from referral to their provider for reevaluation of their therapeutic plan. The PEST screening of patients with psoriasis by pharmacists in a specialty setting identified 11 of 32 patients (34%) who scored a 3 or higher and who may benefit from a referral to a rheumatologist for further assessment of psoriatic arthritis activity.

Conclusion

Specialty pharmacists are an essential part of ongoing assessment and management of patients with chronic inflammatory conditions such as rheumatoid arthritis and psoriasis. Screening and monitoring of patients by pharmacists can identify the need for referral to a medical provider.

Summary Bullets

What is already known about this subject?

Current guidelines for the treatment of rheumatoid arthritis recommend frequent monitoring and reassessment every three months until low disease activity or remission is achieved. Similar screening efforts in patients with psoriasis can help identify the nearly 30% of patients who have undiagnosed psoriatic arthritis. Clinical pharmacists in the specialty setting can assist with these screening initiatives to reduce disease severity and appropriately refer patients for further examination.

What this study adds.

This study demonstrates the ability of clinical specialty pharmacists to administer validated screening tools used in chronic inflammatory disease states to improve patient outcomes.

Disclosures

The authors of this study have no possible financial or personal relationships with commercial entities to disclose that may have a direct or indirect interest in the matter of this study.

Funding source

None.