Adherence to Disease-Modifying Therapies at a Multiple Sclerosis Clinic: The Role of the Specialty Pharmacist.

BACKGROUND: Disease-modifying therapy (DMT) delays disease progression and improves quality of life for patients with multiple sclerosis (MS), but adherence to DMT is often suboptimal. Vanderbilt Specialty Pharmacy (VSP) embeds pharmacists within an outpatient MS clinic to provide medication management and address barriers to adherence. OBJECTIVE: We evaluated rates and predictors of adherence to DMT among patients with MS at an integrated specialty pharmacy. METHODS: We included patients with MS who filled ≥3 DMT prescriptions from VSP during the study period. Adherence was defined as medication possession ratio (MPR) or proportion of days covered (PDC) ≥0.8. Reasons for nonadherence were collected from pharmacy claims and electronic medical records. RESULTS: The study included 653 patients. Average MPR and PDC were 0.93 and 0.94, respectively. Eighty-eight percent of patients achieved MPR ≥0.8; 89% achieved PDC ≥0.8. Using financial assistance and having $0 out-of-pocket cost were associated with higher odds of achieving MPR and PDC ≥0.8 (P < .05). Of the 12% of patients who were nonadherent, most were unreachable for refills. CONCLUSIONS: Ensuring financial assistance and low out-of-pocket costs are associated with high adherence to DMT within an integrated specialty clinic, but more work is needed to address adherence in unreachable patients.

Exercising with Veterans: How Social Interaction with a Pharmacy Student Improves Patient Care.

With the baby boomer population anticipated to explode between 2010 and 2030, it is essential that student pharmacists learn how to properly care for older patients. One way for pharmacy students to prepare for providing health care to the elderly is to partake in an Advanced Pharmacy Practice Experience (APPE) elective course in geriatrics. Pharmacy students, and health care professionals in general, have an immense amount of information available to them that is not found in a patient's chart or textbook, but can be uncovered through increased social interaction with patients, promoting the best possible care. Although these are not novel ideas, this article describes a unique experience I recently had with the veterans at the Alvin C. York Campus of the Veterans Affairs (VA) Tennessee Valley Healthcare System. While completing an APPE elective in geriatrics, I was given the opportunity to attend twice-weekly exercise classes with the veterans. When my preceptor first told me about this project, I was both excited and intrigued because I thought it would be an interesting way to interact with my patients, but I never imagined how much the relationships I formed would positively impact my ability to care for my patients.