Inflammatory Bowel Disease

Maria G. Tanzi, PharmD

Pharmacists involved with caring for patients with inflammatory bowel disease (IBD) can improve quality outcomes by optimizing medication adherence, therapeutic drug monitoring, and patient education, according to data presented at the Advances in Inflammatory Bowel Diseases meeting in December 2019 from a pilot clinic at Kaiser Permanente San Diego Medical Center.

“In my practice, involving clinical pharmacists in the care of patients with IBD has resulted in increased medication adherence and immunization rates,” Shubha Bhat, PharmD, MS, BCACP, clinical pharmacist in the Crohn’s and Colitis Program at Boston Medical Center, told Pharmacy Today. Bhat, who was not involved in the recent study from Kaiser, practices as an outpatient gastroenterology pharmacist on a multidisciplinary team aimed at improving outcomes for patients with GI disorders.

Data suggest improved quality outcomes

The pilot clinic, which started at Kaiser Permanente San Diego Medical Center in September 2018, integrated a clinical pharmacist into the IBD clinic, with the intent to optimize patient education and improve laboratory monitoring and vaccinations before initiating biologics and immunomodulators.

A retrospective analysis of data collected from the pilot from October 1, 2018, to February 1, 2019, showed that pharmacists were involved in 1,243 patient encounters and 1,090 interventions. The primary interventions included laboratory monitoring (32%), medication adherence (26%), therapeutic drug monitoring (10%), and new medication start education (9%).

The researchers noted that the interventions were so well received by the gastroenterologists that they have advocated for continuation of the service moving forward.

Pharmacist interventions across the continuum 

Not all institutions will have the resources for a dedicated GI pharmacist focused on the care of patients with IBD. Bhat said that patients with IBD are often admitted for a flare, which may be attributed to nonadherence or loss of effectiveness to prescribed regimens.

“Inpatient pharmacists can talk to patients to determine if they are nonadherent because they had issues navigating the specialty pharmacy system or believe they didn’t need the medication anymore since they felt well,” Bhat said.

Based on patients’ responses, inpatient pharmacists can then provide targeted interventions to address the issues. Bhat also noted that many patients are discharged on steroids, so counseling on appropriate use, such as explaining how to take the medication and that intended duration is short term, can be extremely useful to patients.

“The transition from inpatient to outpatient can be difficult, particularly if a patient is started on biologic therapy while admitted,” said Timothy Edminster, PharmD, with the inflammatory bowel and celiac disease program in the division of gastroenterology, hepatology, and nutrition at the University of Florida.

“When one of these medications is started, ensuring both the inpatient team and the patient are aware of the need to get the case manager or outpatient team involved as soon as possible to prepare for the transition can be an important intervention.” These interventions can help reduce delays in care with biologic therapy and readmission risk if patients are unable to get continued access to their therapy in a timely manner.

In the outpatient setting, optimization of adherence is essential, along with monitoring for efficacy and safety of treatments. In addition to performing clinical assessments, Bhat said, ensuring patients are up to date on recommended vaccinations and assisting them with the specialty pharmacy process (e.g., prior authorizations, copays, refills) are also key components of her role in caring for patients with IBD.

Patient education essential

For patients with IBD, key counseling pearls should focus on the benefits and risks of available treatment options, appropriate administration and disposal of prescribed treatment regimens, need for routine laboratory monitoring, and the importance of medication adherence for disease control, as well as staying up to date on vaccinations in the setting of immunosuppression.

Edminster noted that biologic agents and other immunosuppressive therapies are an important part of IBD care, and there is a significant amount of misinformation about these treatments. “It is important that the risks of these therapies are adequately discussed and put into perspective, particularly in regard to the risks of untreated IBD, which can have a large impact on a patient’s quality of life,” he said.

By helping patients understand their treatments, pharmacists can help them cope with their disease and boost adherence, which will lead to optimal disease management.