Role and Impact of a Clinical Pharmacy Team at an Inflammatory Bowel Disease Center.

Background: There is limited literature describing the role of a clinical pharmacy team within a tertiary academic inflammatory bowel disease (IBD) center. The goal of this paper is to describe and showcase the clinical and operational impact of an integrated clinical pharmacy team. Methods: This was a retrospective study evaluating the referral outcomes for all patients referred to University of Chicago Medicine Specialty Pharmacy for self-administered advanced IBD therapies covered by prescription insurance from October 1, 2020 to October 31, 2021. Results: A total of 1800 referrals were received for advanced IBD therapies. Prior authorizations (PAs) were required and submitted for 1700 referrals. Of those 1700 PA submissions, 297 (17%) were denied by insurance. To overturn the denials, 344 appeals, including second-level appeals and external reviews, were submitted. Manufacturer patient assistance programs were obtained for 69 patients. From the 1800 referrals, 98% of patients were successfully started on the intended therapy. Clinically, there were 2141 pharmacist-initiated interventions by 2 IBD pharmacists. The most common interventions were prevention in interruption of therapy and providing patient education. Conclusions: Clinical pharmacy teams are well positioned to streamline care within a tertiary academic IBD center. Their unique skillset and ability to provide high yield medication access supports the use of this model as a best practice in IBD centers.

Delays in Therapy Associated With Current Prior Authorization Process for the Treatment of Inflammatory Bowel Disease.

Despite a high approval rate, there were unnecessary delays in therapy due to prior authorizations. This study identified the impact of type of IBD, FDA-labeled indication, and dose escalations on approvals.

Uncertainty evaluation and performance assessment of water quality model for mariculture management.

Ecosystem based water quality models are important tools for prognostic site assessment and evaluation of ecosystem-performance of marine fish farms. We present the development and application of a comprehensive Fish Culture Zone Water Quality Model using continuous bi-weekly field data over a six-year period (2012-2017). The model simulates five interacting subsystems: phytoplankton, phosphorus and nitrogen cycles, and the dissolved oxygen (DO) and particulate organic carbon balance. The application of the model to two fish culture zones in Hong Kong shows the model captures the trends of nutrient and DO variation and the performance in quantitative prediction of algal biomass is challenging. The effect of errors in the specification of primary model inputs are evaluated using dimensionless sensitivity coefficients based on First Order Variance Analysis reveals the relative importance of fish stock (loading), physical size (volume), tidal flushing rate and boundary conditions in the prediction of key water quality variables.

Practical considerations when treating chronic hepatitis E in solid organ transplant recipients.

Hepatitis E virus (HEV) can lead to chronic infections in immunosuppressed patients. The use of ribavirin to treat chronic HEV has been well-established in case reports and guidelines. However, practical approaches to the use of this antiviral treatment in a post-transplant patient, including drug interactions, dosing adjustments, and monitoring parameters, are lacking. Thus, we present our real-world approach to the use of ribavirin to treat chronic HEV in a solid organ transplant recipient.