Abstract
Background: On 26 September 2016, the FDA approved ustekinumab for the treatment of Crohn’s disease, which uniquely requires administration via two distinctly different methods, induction intravenous infusion followed by maintenance of subcutaneous self-injection. While therapeutically appropriate, the two dosing methods present administrative challenges beyond currently available treatments including verification of insurance coverage for both medical and pharmacy benefit, coordination of medication distribution, and care coordination and communication between the infusion service and specialty pharmacy. To ensure continuity of care, the successful facilitation of this process requires a care system that has experience in managing both infusion and specialty pharmacy medications.
Objectives: Describe process and key learnings for complex therapy administration.
Methods: In this descriptive analysis we characterize the patient, provider, and dispensing process across multiple sites of care. We highlight common scenarios experienced by patients and summarize unique challenges of coordinating treatment across multiple care settings.
Results: Prior to the approval of ustekinumab, Fairview Pharmacy Services identified potential gaps in coordination between different the clinical settings and partnered with the health system, local clinics, and infusion centers to seamlessly coordinate care across medication delivery settings. A designated Specialty Care Coordinator is responsible for performing end-to-end communication and coordination of all activities for patients to ensure the transition between delivery settings does not result in gaps in therapy. Since process implementation, Fairview has successfully coordinated ustekinumab administration for over 200 patients within and external to our health system to ensure all patients received the intravenous induction dose prior to receiving the subcutaneous maintenance dose. In addition, we identified scenarios where lack of coordination can result in disruption to treatment for the patient or medication waste to the healthcare system.
Conclusions: Health system owned specialty and infusion pharmacy services are uniquely positioned to facilitate and coordinate a successful transition of complex therapy with minimal disruption across various clinical settings. Fairview Pharmacy Services unique care model and partnerships are equipped to handle both our own patients and those being seen outside the system.
Presenter:
Poster abstracts from the Annual Meeting and Educational Conference for NASP (the National Association of Specialty Pharmacy), September 24–26, 2018, Washington, DC.