Implementation of a pharmacist‐managed population health monitoring tool for disease modifying therapies in treatment of patients with multiple sclerosis in a veterans affairs medical center

Abstract

AbstractIntroductionMultiple sclerosis is a chronic demyelinating disease of the central nervous system that requires treatment with disease modifying therapies (DMTs). Use of DMTs has been associated with potential safety concerns dictating the need for medication monitoring.ObjectivesThe purpose of this project was to (1) establish specific guidelines for DMT monitoring that would be used to create a population health management (PHM) tool via electronic dashboard to allow targeted patient interventions by the neurology clinical pharmacy specialist, and (2) describe pharmacist interventions before and after dashboard implementation.MethodsMedication safety monitoring parameters were developed and utilized to implement a dashboard for DMT monitoring at a Veterans Affairs Medical Center (VAMC). Qualifying DMTs included interferon beta‐1a/1b formulations, fingolimod, teriflunomide, and dimethyl fumarate. A standardized DMT medication ordering menu and note template were also developed. A retrospective chart review was conducted to assess compliance with recommended monitoring in the 6 months prior to dashboard implementation (descriptive phase) and 6 months after dashboard implementation (implementation phase).ResultsPrior to dashboard implementation, 40 patients were identified with a qualifying DMT prescription. Of those, 8 (20%) had an abnormal laboratory result, 26 (65%) lacked baseline testing, mostly complete blood counts (CBCs) and liver function tests (LFTs), and 17 (42.5%) lacked follow‐up monitoring. Of the 39 patients with a qualifying DMT prescription after dashboard implementation, 4 (10%) had an abnormal laboratory result and 4 (10%) lacked follow‐up monitoring. Eight patients were started on a new DMT, and of those 1 (12.5%) lacked baseline monitoring. Total pharmacist interventions decreased from 128 to 67 after process improvements and dashboard implementation.ConclusionDevelopment of standardized DMT monitoring guidelines and dashboard implementation resulted in improved DMT monitoring at this VAMC. This PHM approach to patient care allowed for targeted pharmacist interventions to improve patient safety and medication adherence.