P099 Implementation of an Inflammatory Bowel Disease Clinical Pharmacy Service
Authors: Thanh Danielle Mae , Kandilian Rebecca , Nguyen Khanh 
Published: December 2019

BACKGROUND:
Inflammatory bowel disease (IBD) is a group of chronic inflammatory illnesses with a relapsing and remitting course often complicated by flares requiring hospital visits and/or surgeries. Numerous studies have outlined the role of a clinical pharmacists within IBD. The primary role of the clinical pharmacists in the published literature includes ensuring safe and effective use of biologics and immunomodulators through patient education and close monitoring of recommended laboratory tests. Further, the studies demonstrate the effectiveness of a clinical pharmacist in increasing adherence to medication therapy and in reducing the number of clinic visits. However, there has yet to be a study that ties such interventions to clinical or economic outcomes that demonstrate the potential long-term impact of a clinical pharmacist in IBD management. At Kaiser Permanente San Diego Medical Center, a pilot clinic was started in September 2018 where a clinical pharmacist was integrated within the IBD clinic. The primary role of the clinical pharmacist included patient education, baseline laboratory testing and vaccinations prior to initiating patients on biologics and immunomodulators, therapeutic drug monitoring, and routine laboratory testing prior to refilling medications.

METHODS:
The study is a descriptive, retrospective study conducted from October 1, 2018 to February 1, 2019. The study methods consisted of establishment of a Pharmacy & Therapeutics (P&T) approved protocol, which will define an approved workflow for the clinical pharmacist within the Gastroenterology clinic. Baseline and post-clinic implementation data were collected for analysis. The purpose is to determine the role of a pharmacist in IBD management & can they make an impact on quality and cost of care. One full-time equivalent pharmacist’s interventions were classified and quantified during this time frame.

RESULTS:
The pharmacist’s workflow begins with the IBD pharmacist receiving the referral from the gastroenterologist. IBD Pharmacist conducts full patient work up, including medication reconciliation to make interventions and contacts patients. IBD Pharmacist collaborates with gastroenterologist as needed to discuss complex treatment cases. Of 1,243 patient encounter reviews, 1,090 interventions were classified. Lab monitoring was the leading intervention accounting for 32% of all interventions followed by Medication adherence 26%, therapeutic drug monitoring 10%, and new start education 9%.

CONCLUSION(S):
Overall, pharmacists can potentially improve quality outcomes by increasing lab and medication adherence. Pharmacist-managed IBD service may result in more cost-effective use of medications. The IBD pilot clinic was well-received by our gastroenterologists and they have unanimously advocated for continuation of the service. Future studies using a control center to compare with our center with a clinical pharmacist within the workflow may provide more direct insight on impact of quality and cost of care.