Interprofessional collaboration between general practitioners and community pharmacists to promote the safe and responsible use of TNF-α-inhibitors.

Abstract

Introduction: Tumor necrosis factor α-inhibitors (TNF-α-inhibitors) are biological disease-modifying anti-rheumatic drugs (bDMARD’s) that are used in the treatment of different immune mediated inflammatory diseases (IMIDs) (eg. rheumatoid arthritis, psoriasis, Crohn’s disease…). TNF-inhibitors are generally well tolerated and safe, but some major challenges remain in the management of TNF-inhibitors. 
 First of all, only specific specialists (rheumatologist, dermatologist, ophthalmologist, gastro-enterologist) can prescribe these drugs. This implicates that GP’s often are not aware that patients use these drugs. Secondly, patients on TNF-therapy are more susceptible to opportunistic infections (eg influenza of bacterial infection). Recognizing symptoms to refer to the GP is essential and vaccination is highly recommended. Lastly, drug adherence is too low, which impacts the disease activity and clinical outcome. 
 Policy Context And Objective: In 2018, the Royal Association of Pharmacists in Antwerpen (KAVA) and Domus Medica have developed a quality improving program (QIP) in the context of Medical-Pharmaceutical Concertation (MPC). MPC is an initiative from the NIDHI in Belgium to promote the rational prescribing and dispensing of medication and the safe use of medication in general. The NIHDI provides financial incentives to general practitioners (GP) and community pharmacists (CP) to organize local MPC-projects, based on a QIP. A local MPC-project starts with a ‘kick-off meeting’, to make agreements of the rational use of medication. Most of the time, different cases are discussed in small interprofessional groups. After this meeting, the agreements are subsequently implemented into practice and can be evaluated with quality indicators. 
 This specific QIP focusses on four challenges: (1) to improve the influenza vaccination coverage in this group of patients, (2) to stimulate the communication between GP and CP, (3) to educate GP, CP and patients about the alarm symptoms of infections and (4) to improve patient adherence.
 Target Population: MPC targets the general practitioner and community pharmacist with mutual patients on TNF-therapy.
 Highlights: The Royal Association of Pharmacists in Antwerpen (KAVA) and the GP organization Domus Medica strongly believe in this initiative. Currently 13 local MPC-projects have been organized in which 68 CP and 118 GP participated. The three most important conclusions of these MPC-projects are;
 •GPs want to know which patients are on TNF-therapy, the CP can play an active role in the identification of these patients in the GP practice;
 •The influenza vaccination coverage is unknown in the pharmacy and GP practice. This will be checked after the MPC. Advocating and sensitization campaigns are useful and will he implemented and evaluated afterwards;
 •Referring to GP in case of alarm symptoms is necessary and should be done sooner.
 Conclusion: MPC is an initiative from the NIDHI in Belgium to promote the rational prescribing and dispensing of medication and the safe use of medication in general. KAVA and Domus Medica have developed a quality improving program, specifically targeted on TNF-inhibitors. Currently, 13 local MPC-projects have been organized. Further research is necessary to analyze the impact of the MPC-project.