THU0771-HPR Incorporating senior pharmacist input in teriparatide pathway ensures adherence to prescribing guidance - audit/quality improvement results from a district rheumatology unit
Authors: W Gan, L Bromilow, S Vasireddy
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Teriparatide is licensed for upto two years to treat severe osteoporosis. It is the most expensive osteoporosis treatment available (around £ 3500 per year). Hence a locally adapted national NICE guidance is used for prescribing in our department, but the previous level adherence was uncertain. In 2011, a directory of services was agreed for our metabolic bone clinic. At the time a Rheumatology senior pharmacist review with the prescribing senior clinician was agreed on our teriparatide treatment pathway, including pre-treatment DXA, and a specified bone profile screen before treatment and for repeat prescribing at specified intervals. The agreement also incorporated access for our patients to senior pharmacist advice if needed via the department9s secreterial team. <h3>Objectives</h3> Our objective was to assess the impact of the senior pharmacist input on our adherence to the agreed guidelines in our Teriparatide pathway, including assessing treatment completion and response. <h3>Methods</h3> Patients with osteoporosis who were started on Teriparatide between 2011–2015 were identified from pharmacy prescribing spreadsheets. A retrospective review of case notes of all patients were carried out. Data including age, gender, prior agents tried, pre-treatment bone profile, pre and post treatment DXA, and treatment completion were collected on a Microsoft Excel 2010 spreadsheet for processing and descriptive statistics. <h3>Results</h3> 33 patients who were started on teriparatide treatment between 2011–2015 were identified (29 female and 4 male). Mean age was 76.2 (range 63–92). All had pre-treatment DXA, and 32 (97%) were compliant with recommendations for initiation of teriparatide treatment with respect to DXA (one patient borderline). All 33 patients had a pre-treatment bone profile within acceptable limits before start of treatment (adjusted Calcium, Serum Parathyroid Hormone, Vitamin D level, e-gfr). 28 (84.8%) patients tried one agent before initiation of Teriparatide treatment and 5 (15.2%) patients tried 2 agents. 24 (72.7%) patients completed the full course of recommended treatment. 11 out of 24 patients who completed Teriparatide treatment have had post-treatment DXA. 3 out of 24 patients who completed Teriparatide treatment had a fragility fracture after treatment. <h3>Conclusions</h3> This audit confirms the benefit of incorporating Rheumatology senior pharmacist review in the pathway from the excellent compliance with guidelines in initiating and managing Teriparatide noted in the results. This is likely to have also contributed to the high completion rate of the treatment course. However, only 11 out of 24 had post treatment DXA, and this needs improvement by the next audit cycle, through input of senior clinicians who are in charge of requesting DXA. We would, therefore, recommend incorporating senior pharmacist input for review in teriparatide treatment pathways routinely. <h3>Disclosure of Interest</h3> None declared