Use of protocol-driven medication refills by pharmacists decreases rheumatologist in-basket work and improves rheumatologist satisfaction.

Burn-out among US physicians has been on the rise in the past few decades. Similarly, rheumatologists in the Geisinger Health System have experienced professional dissatisfaction through significant administrative burden and in-basket work. We embedded pharmacists into our rheumatology team in 2019 with the aim of reallocating medication refills to pharmacists, trained professionals in this domain, to help reduce physician workload and burn-out and increase satisfaction. Protocol-driven medication refill parameters per the American College of Rheumatology guidelines and new refill workflows for disease-modifying antirheumatic drugs (DMARDs) and non-DMARDs were created for use by our rheumatology pharmacists. Monthly data on medication refill volume and time saved for rheumatologists were collected from 1 January 2019 to 31 March 2021. Statistical analysis was completed via Shewhart p-charts. The volume of refills by rheumatologists decreased by 73% and the time saved per month for all the rheumatologists increased to 41.5 hours within 6 months. Physicians' feedback was obtained via anonymous electronic surveys preintervention and postintervention. The statistical difference between the presurveys and postsurveys was calculated via two-tailed unpaired t-testing. It demonstrated reduced burn-out and improved workplace satisfaction. This study showed that the integration of rheumatology pharmacists into our practice can help improve the work life of the rheumatologists. It is important for physicians' well-being to practice at the top of their scope and achieve work-life balance.

Silicone synovitis: longer term outcome data and review of the literature.

BACKGROUND: Silicone had been popular for small and medium joint prostheses from the 1960s until the 1980s when concerns about subsequent arthritis arose. There are still patients with long-standing silicone prostheses. We describe 7 cases of synovitis attributed to these. METHODS: This is a case series of patients having synovitis in the vicinity of a silicone arthroplasty. The diagnosis was determined by examination and, radiographic and operative characteristics of the joint. Underlying diseases of the patients, treatment strategies, and responses to treatment were reviewed. RESULTS: Seven charts were reviewed. The ages ranged from 53 to 90 years (mean = 71.5). Two patients had osteoarthritis, 1 had rheumatoid arthritis, 3 had trauma, and 1 had avascular necrosis. Joints included 2 metatarsal phalangeal, 3 carpal bones, 1 radial head, and 2 first carpal metacarpals. The time from arthroplasty to synovitis was 9 to 30 years (mean = 16). Five patients had surgical management and 2 had medical management. Four of the surgically managed patients had resolution of their symptoms, 1 had a recurrent synovitis requiring further surgery. One person had 2 arthroplasties, but developed synovitis at only 1 site. The 2 patients medically managed continued to have synovitis. CONCLUSIONS: Synovitis continues to be a consequence of silicone arthroplasty. It can be a late complication with our shortest time to synovitis being 9 years. Underlying pathology does not seem to predict the synovitis as patients with osteoarthritis, rheumatoid arthritis, avascular necrosis, and trauma are all represented. Surgically managed patients did well, whereas patients managed medically did not have resolution of their symptoms.