Recognizing Pharmacists’ Vital Role in Clinical Programs during National Pharmacy Week
At essential hospitals and health systems nationwide, pharmacists play a vital role in improving access to care and optimizing patient care. This National Pharmacy Week, Oct. 20 – 26, we spotlight pharmacists’ unique opportunity to help eliminate hepatitis C (HCV) and human immunodeficiency virus (HIV) infections as a public health threat. We also recognize the importance of operationalizing clinical programs within hospitals and health systems. This model allows pharmacists to play a key role in eliminating barriers to screening services, improves medication access and affordability, and facilitates continuity of care.
PHARMACISTS ARE WELL POSITIONED TO OVERSEE CLINICAL PROGRAMS
Clinical programs are designed to focus on specific disease states and provide a comprehensive service directly to patients. According to a recent study in Cureus, front-line clinical staff play an important role in shaping patient experience — an essential aspect of medical care, encompassing patients’ actual experiences and feedback. To do this effectively, training and education are necessary to deliver exceptional service.
Pharmacists, as part of the care team, are well positioned to take a role in overseeing clinical programs within a health system, working directly with a patient, providers, and staff to improve access to care and personalize support. Health system specialty pharmacists also can access and work inside patients’ integrated electronic health records. This can further their unique capability to work directly with the patient’s care team and contribute to comprehensive management and improvement of patient outcomes through:
- Patient education and engagement to increase patient awareness on the need for screening and current treatment options
- Expanding screening services and making them easily available to high-risk communities
- Streamlining the treatment plan for a seamless transition from diagnosis to linkage to care
- Developing patient support programs to make treatment readily accessible and affordable
- Maximizing treatment completion and cure rates though patient engagement and by providing medication adherence and adverse effect management services via telehealth
- Partnering with provider offices to make sure patients follow through on their treatment or cure confirmation laboratory studies
CLINICAL PHARMACIST-LED HEPATITIS C PROGRAM MINIMIZES ATTRITION RATE AND IMPROVES LINKAGE TO CARE
The World Health Organization (WHO) and U.S. national strategic plan aim to achieve a 90 percent reduction in HCV infection and increase HCV diagnoses by 90 percent by 2030. However, the 2023 National Progress Report indicated that acute HCV infections have been steadily on the rise—a 60 percent increase from 2017 and 7 percent increase from 2022. A recent study shows one in three adults in the United States are not aware of their potentially life-threatening infection. At the time of diagnosis, around 20 percent of patients already will have serious liver damage, cirrhosis, and/or end-stage liver disease. Results of a recent study found the average national HCV cure rate is 35 percent, highlighting the need for a comprehensive screening program for early diagnosis and linkage to care.
To minimize attrition from diagnosis to linkage to care, Clearway Health conceptualized a pharmacist-led, system wide HCV screening and linkage to care program in a rural community health center. The pharmacy department collaborated with the family medicine residency program at the health center to link patients to care.
In this model, a pharmacist monitored the HCV screening lab results dashboard that was refreshed weekly. When an HCV-infected patient was identified, the pharmacist contacted the lab-ordering provider to facilitate a discussion of the diagnosis with the patient, referred the patient to the HCV clinic, and ensured linkage to care. Once treatment began, the pharmacist followed up with patients at four weeks, eight weeks, and end-of-treatment (EOT), and ensured that EOT and sustained virologic response 12 weeks post–end of treatment (SVR-12) labs were completed.
During the four months of the study, the health system screened 1,416 patients and identified 39 patients with detectable HCV RNA, of whom 67 percent were linked to HCV care and started treatment. Compared with 2023, the pharmacist-led test-to-treat model resulted in a 116 percent increase in linkage to HCV care. Implementing a pharmacist-led, clinical dashboard–supported test-to-treat protocol helped minimize the attrition rate in the HCV treatment cascade and improved linkage to care, medication access, and adherence.
CLINICAL PHARMACISTS PROVIDE COMPREHENSIVE HIV MANAGEMENT AND IMPROVE PATIENT OUTCOMES
Health system specialty pharmacists play crucial roles in various aspects of HIV care, contributing to the comprehensive management and improvement of patient outcomes. Viral load suppression reduces the risk of transmitting the virus to others; it also helps preserve and restore immune function by maintaining or increasing CD4+ T-cell counts, helping people living with HIV lead healthy lives.
Once patients achieve viral load suppression, supporting their transition into less burdensome therapeutic options is key to improve quality of life without risking therapeutic failure. One way to monitor this is by routine viral load and CD4 levels. When the CD4 level is <200 cells/mm3, patients are at high risk of developing opportunistic infections and developing AIDS. Integrated clinical pharmacists are ideally positioned to support patients and the care team to ensure optimal therapeutic outcomes.
A multicenter, retrospective observational study by Clearway Health evaluated the role of pharmacists in HIV management beyond viral suppression. Among 553 patients from three health centers enrolled in Clearway Health specialty care management program, 96 percent of patients achieved viral load suppression. Additionally, 95 percent of patients had CD4 counts >200, 4 percent had CD4 count between 100–200 cells/mm3, and 1 percent had CD4 count <100 cells/mm3.
Simplification of the HIV regimen is a key part of improving medication adherence, convenience, and outcomes. Pharmacists educate and support patients to transition to a long-acting injectable antiretroviral therapy and maintain their viral suppression and CD4 count >200 cells/mm3. The role of pharmacists in this HIV management study included medication access support, medication and disease state education, therapy modifications, adverse event management, therapy lab monitoring, opportunistic infection prophylactic and managing medication orders, and significantly improved patient care and outcomes.
While National Pharmacy Week allows an opportunity to showcase the incredible work pharmacists implement to enhance patient care, progress also indicates great potential. Clinical programs for HCV and HIV are more routinely seen in health systems; however, operationalizing a clinical program championed by specialty pharmacy could make a difference in unrealized disease states. It will be important for leaders of health systems to think outside of the box when deciphering how to minimize and eliminate various diseases. The field of pharmacy will continue to evolve as more health systems and patients reap the benefits of specialty pharmacy clinical programs.