Prescribing Excellence: The Symphony of Dermatology Care with Clinical Pharmacists

The 2024 Masterclasses in Dermatology conference presented a notable poster on the impact of a clinical pharmacist in an outpatient dermatology clinic. The focus of the study was the Mount Sinai Union Square Dermatology Clinic in New York, New York, a resident-teaching clinic led by an attending physician, with a particular emphasis on conditions such as psoriasis vulgaris, psoriatic arthritis, and hidradenitis suppurativa. Research was led by Tatyana Bazarova, PharmD, BCACP, and Alice Gottlieb, MD, PhD, dermatologist and rheumatologist at Mount Sinai Union Square.The introduction of clinical pharmacy practice in January 2020 aimed to address the challenges associated with biologic medication therapy, including routine monitoring, complexity of use, and insurance restrictions.¹

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Clinical Pharmacist Services and Workflow

The clinical pharmacy services at Mount Sinai Union Square Dermatology Clinic encompassed a range of crucial interventions. These include pre-treatment assessment for biologic therapy, injection training, medication counseling, and assistance with medication access. The interventions were meticulously documented in the electronic health record and a secure, password-protected Excel file. The study, conducted from January 2020 to December 2022, employs descriptive statistics to review the quantity and types of interventions made by the clinical pharmacist.

Challenges in Biologic Medication Therapy

Biologic therapies have proven efficacy in dermatological conditions², but their implementation is not without challenges. Routine laboratory monitoring, the complexity of use, and insurance restrictions are substantial barriers that patients often face. The need for a comprehensive approach to patient care in dermatology prompted the integration of clinical pharmacists to work collaboratively with physicians.

Impact of Clinical Pharmacist Interventions

The study sheds light on the collaborative efforts between physicians and clinical pharmacists in enhancing patient care. Pharmacist interventions in dermatology spaces play a pivotal role in improving treatment outcomes and addressing patient needs efficiently. The one-on-one pharmaceutical care consultations provided by clinical pharmacists significantly contribute to patient self-management of biologic drug therapy.

Clinical Pharmacist Visit Workflow

When a provider initiates a patient on a biologic medication, the clinical pharmacist steps in to provide initial medication counseling. If the therapy involves infusion or provider-administered methods, the patient is referred to the Infusion Center. For self-injectable therapies, the prescription is sent to a specialty pharmacy for processing, and a one-on-one clinical pharmacist visit is scheduled.

During the clinical pharmacist visit, a pre-treatment assessment for biologic therapy is conducted. This includes evaluating immunization status, medication history, allergies, infection risk, and pertinent lab reviews. The pharmacist also provides biologic injection training and counseling, covering aspects such as adverse events, medication adherence, and missed doses.

A 2-week follow-up involves a telephone call to address potential side effects and medication-related questions, ensuring ongoing support and monitoring for patients on biologic therapy.

Conclusion and Future Directions

The findings from this quality improvement project underscored the significant role clinical pharmacists play in outpatient dermatology clinics, especially in the context of biologic therapy. Collaborative efforts between physicians and clinical pharmacists prove to be a valuable strategy in improving patient outcomes and overall quality of life.

The poster not only highlights the current successes but also emphasizes the need for future studies to focus on dermatology-related quality measures. By continuing to explore and document the benefits of clinical pharmacist interventions, dermatology clinicians can further refine their approach to patient care and continue to provide innovative and effective solutions for individuals with complex dermatological conditions.

References

1. Bazarova T, Gottlieb A. Impact of a Clinical Pharmacist in an Outpatient Dermatology Clinic. Poster presented at: Masterclasses in Dermatology February 16-19, 2024; Puerto Rico.
2. Yao Y, Ravn Jørgensen AH, Thomsen SF. Biologics for chronic inflammatory skin diseases: an update for the clinician. J Dermatolog Treat. 2020;31(2):108-130. doi:10.1080/09546634.2019.1589643