Implementing a pharmacist-run Lyme disease postexposure prophylaxis clinic augmented by academic detailing within the Veterans Health Administration

Abstract

ObjectiveTo describe the implementation of a pharmacist-run Lyme disease postexposure prophylaxis (PEP) clinic augmented by academic detailing within a health care system. SettingButler Veterans Affairs Health Care System. Practice descriptionA pharmacist-run clinic, referred to as a PharmLD clinic, was established. A patient presenting to the health care system with a chief complaint of a tick bite would be scheduled to the PharmLD clinic for the evaluation of appropriateness of Lyme disease PEP. The pharmacist prescribed a single dose of doxycycline 200 mg and provided education on Lyme disease, provided education only, or referred the patient to their primary care provider (PCP). Academic detailing with PCPs, nurses, and pharmacists was used to improve outcomes in those not seen in the clinic. Practice innovationTo our knowledge, the evaluation of a pharmacist-run Lyme disease PEP clinic in a health care system alone or in combination with academic detailing has not been previously described in the literature. EvaluationDoxycycline PEP prescriptions from April through September 2016 (preimplementation) were compared with prescriptions from April through September 2018 (postimplementation). A retrospective chart review was performed to evaluate prescribing appropriateness on the basis of Infectious Diseases Society of America guidelines. ResultsThe postimplementation group saw a 55.9% improvement in doxycycline prescribing appropriateness. The improvement in appropriateness stemmed largely from the dose and duration prescribed. Eighteen of the 39 prescriptions (46%) came from the PharmLD clinic. During the postimplementation period, 40 patients were seen in the PharmLD clinic. Of these patients, 18 were prescribed doxycycline PEP (45%), 12 received education only (30%), and 10 were referred to their PCP for further evaluation (25%). These PharmLD clinic encounters resulted in the mitigation of 30 PCP visits. ConclusionA pharmacist-run Lyme disease PEP clinic, coupled with academic detailing, has increased access to care and improved the quality of care received.