POS1496-HPR IMPROVING PATIENT SAFETY VIA THE DEVELOPMENT OF A PHARMACIST-LED GLUCOCORTICOID COUNSELLING SERVICE
Authors: D. Taylor, C. Underhill, D. Young, D. Wallis
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Glucocorticoids are prescribed in high doses for giant cell arteritis (GCA) and polymyalgia rheumatica (PMR). Prolonged glucocorticoid exposure is associated with complications including osteoporosis, diabetes mellitus, cataracts, glaucoma, infection, hypertension, adrenal insufficiency and psychological effects. Guidelines recommend education of patients about treatment with glucocorticoids including symptoms of withdrawal and "sick day rules". The heavy burden of information given at diagnosis and limited time available make comprehensive counselling in the clinic setting challenging. It is widely documented that counselling by pharmacists improves medication adherence and patient understanding of their medication. <h3>Objectives:</h3> To develop and evaluate a pharmacist-led glucocorticoid counselling service for patients starting long term, high dose treatment. <h3>Methods:</h3> Patients initiated on prednisolone (oral glucocorticoid) for vasculitis including GCA or PMR were referred by the clinician to the rheumatology specialist pharmacists for counselling. The counselling was provided within one week either face-to-face or over the telephone using a standardised questionnaire. Structured counselling included a review of adjunctive medication, guidance on "sick day rules" and advice on the complications associated with prednisolone. An independent engagement officer contacted patients at least two weeks after the counselling to gain feedback about the experience. <h3>Results:</h3> From 14/08/2023 to 28/12/2023 a total of 45 patients were contacted for prednisolone counselling (69% female, average age 71 years). The most common diagnosis was GCA and the median duration of the counselling was 20 minutes. 64% (29/45) of the patients had no previous exposure to oral glucocorticoids. 78% (35/45) of patients were unaware of at least one of the key counselling points (Figure 1). Patients who received a general glucocorticoid information leaflet at their initial clinic appointment or had previously taken oral glucocorticoids did not appear to have greater understanding than those who had not. Only 15% (7/45) of patients were given information on "sick day rules" prior to pharmacist counselling. Despite receiving this written information, understanding in these seven patients was poor. One patient had scheduled surgery arranged for one day after the counselling and was unaware of the risks. The pharmacist advised the patient to urgently contact the surgical team who subsequently altered his surgical management. Baseline HbA1C was completed in 75% (34/45) of patients (mean 41 mmol/mol). At the time of counselling 27% (12/45) of patients reported at least one recognised side effect of glucocorticoids, most commonly insomnia. Of concern, many patients were unaware that they needed to obtain further supplies of the prednisolone to avoid unintentional discontinuation. Of 23 patients completing the post-counselling telephone questionnaire, 91% (21/23) of patients were highly satisfied with the counselling and 87% (20/23) reported better understanding of prednisolone and its risks. <h3>Conclusion:</h3> Implementation of a standardised glucocorticoid counselling process by specialist pharmacists has improved the quality of information given to patients. Additionally, it enabled the identification and rectification of gaps in monitoring for adverse events and increased patient safety. Our service identified that providing patients with written information alone is inadequate and that counselling outside of the clinical consultation is effective and well-received by patients. <h3>REFERENCES: NIL. Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> Deborah Taylor: None declared, Caron Underhill Advisory board for abbvie, David Young Speaker for Galapagos, Dinny Wallis: None declared.