Evaluation of the impact of a clinical pharmacist on a specialty neurology clinic’s adherence to recommended laboratory test monitoring

BACKGROUND: Pharmacists can have a significant effect on the specialty ambulatory care setting. Specialty medications are potentially high risk and may require frequent laboratory test monitoring to assess for therapy-associated adverse effects. Pharmacists may work under collaborative drug therapy management agreements that allow for the ordering and assessment of recommended laboratory tests in order to optimize safe and effective medication use. The impact of pharmacists on clinic adherence to recommended laboratory test monitoring has yet to be described in the literature. OBJECTIVE: To describe the impact of a specialty clinical pharmacist on neurology clinic adherence to manufacturer-recommended laboratory test monitoring. METHODS: This study was a retrospective chart review at a single academic medical center for the period between July 1, 2014, and April 30, 2020, comparing laboratory test monitoring adherence before (prepharmacist) and after (post-pharmacist) incorporation of a pharmacist into a neurology clinic. Patients were included if they lived in the Tri-County Area of Charleston, South Carolina, and received a prescription for dalfampridine, dimethyl fumarate, fingolimod, teriflunomide, or cannabidiol that was prescribed by a neurology clinic provider at the Medical University of South Carolina. Chart review was conducted to assess clinic adherence with manufacturer-recommended laboratory test monitoring. Laboratory test monitoring was considered adherent if obtained within 6 months before or on the date of prescription order. Descriptive statistics were calculated for all variables, and adherence rates were compared using chi-square or Fisher’s exact tests. RESULTS: For dalfampridine, dimethyl fumarate, fingolimod, and teriflunomide, there were 123 patients and 78 patients in the pre- and post-pharmacist groups, respectively. There were 51 patients in the cannabidiol group. Clinic adherence to laboratory test monitoring improved in the post-pharmacist group for every monitoring point, with statistically significant improvement in “hepatic function tests every 6-9 months” (P = 0.005), “CBC every 6-9 months” (P = 0.01), and “VZV IgG titer at baseline” (P = 0.005) for patients taking fingolimod. CONCLUSIONS: Our study demonstrated improved adherence to manufacturer-recommended laboratory test monitoring after a specialty clinical pharmacist was incorporated into a multidisciplinary neurology clinic.