Development of a process to improve medication adherence in patients with rheumatoid arthritis in the specialty pharmacy setting

Objective: To develop a disease-specific patient questionnaire to be used during monthly follow-up telephone calls ("refill calls") for patients with rheumatoid arthritis receiving a noninfused biologic medication. Setting: Independent specialty community pharmacy in North Carolina. Practice description: Realo Specialty Care was formed to provide a patient-centered care approach to patients with complex, chronic conditions such as HIV/AIDS, hepatitis, rheumatoid arthritis, and plaque psoriasis. The services include medication therapy management, patient education, prior authorization assistance, adverse drug reaction monitoring, and an adherence program. Practice innovation: Using national guidelines, an 8-item questionnaire that addressed overall health, adherence, and adverse medication events for noninfused biologic medications for rheumatoid arthritis was developed. When an eligible patient was identified, a notification was added within the pharmacy's dispensing software. The pharmacist or technician was prompted to use the newly developed questionnaire during the monthly refill call. Evaluation: Patients' responses were archived in their profiles within the pharmacy's dispensing software. The change in adherence was assessed by the mean medication possession ratio (MPR) before the intervention (July 2018 to September 2018) and monthly after the intervention (November 2018 to February 2019). Results: A total of 29 patients were eligible on the basis of an MPR less than 90%; data from 18 patients were used. The mean MPR increased from 71% preintervention (September 2018) to 75% in the first month after the start of the intervention (November 2018). The mean MPR reached a high of 81% in the fourth month after the start of the intervention (February 2019), representing a 10% increase in the MPR. Conclusion: The specialty pharmacy team successfully developed and used the rheumatoid arthritis questionnaire during the monthly refill calls. The implementation of the disease-specific questionnaire led to increased medication adherence and enhanced communication with patients with regard to their health and outcome of therapy. (C) 2020 Published by Elsevier Inc. on behalf of the American Pharmacists Association.