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.

Phase diagrams of the antiferromagnetic XY model on a triangular lattice with higher-order interactions

We study the effects of higher-order antinematic interactions on the critical behavior of the antiferromagnetic (AFM) XY model on a triangular lattice using Monte Carlo simulations. The parameter q of the generalized antinematic (ANq) interaction is found to have a pronounced effect on the phase diagram topology by inducing new quasi-long-range ordered phases due to competition with the conventional AFM interaction as well as geometrical frustration. For values of q divisible by 3, the ground-state competition between the two interactions results in a frustrated canted AFM phase appearing at low temperatures wedged between the AFM and ANq phases. For q nondivisible by 3, with the increase of q one can observe the evolution of the phase diagram topology featuring two (q=2), three (q=4,5), and four (q≥7) ordered phases. In addition to the two phases previously found for q=2, the first new phase with solely AFM ordering arises for q=4 in the limit of strong AFM coupling and higher temperatures by separating from the phase with the coexisting AFM and ANq orderings. For q=7, another phase with AFM ordering but multimodal spin distribution in each sublattice appears at intermediate temperatures. All these algebraic phases also display standard and generalized chiral long-range orderings, which decouple at higher temperatures in the regime of dominant ANq (AFM) interaction for q≥4 (q≥7) preserving only the generalized (standard) chiral ordering.

Adherence to self-administered biologic disease-modifying antirheumatic drugs across health-system specialty pharmacies

Disclaimer

In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Purpose

Adherence to self-administered biologic disease-modifying antirheumatic drugs (bDMARDs) is necessary for therapeutic benefit. Health-system specialty pharmacies (HSSPs) have reported high adherence rates across several disease states; however, adherence outcomes in rheumatoid arthritis (RA) populations have not yet been established.

Methods

We performed a multisite retrospective cohort study including patients with RA and 3 or more documented dispenses of bDMARDs from January through December 2018. Pharmacy claims were used to calculate proportion of days covered (PDC). Electronic health records of patients with a PDC of <0.8 were reviewed to identify reasons for gaps in pharmacy claims (true nonadherence or appropriate treatment holds). Outcomes included median PDC across sites, reasons for treatment gaps in patients with a PDC of <0.8, and the impact of adjusting PDC when accounting for appropriate therapy gaps.

Results

There were 29,994 prescriptions for 3,530 patients across 20 sites. The patient cohort was mostly female (75%), with a median age of 55 years (interquartile range [IQR], 42-63 years). The original(ie, prereview) median PDC was 0.94 (IQR, 0.83-0.99). Upon review, 327 patients had no appropriate treatment gaps identified, 6 patients were excluded due to multiple unquantifiable appropriate gaps, and 420 patients had an adjustment in the PDC denominator due to appropriate treatment gaps (43 instances of days’ supply adjusted based on discordant days’ supply information between prescriptions and physician administration instructions, 11 instances of missing fills added, and 421 instances of clinically appropriate treatment gaps). The final median PDC after accounting for appropriate gaps in therapy was 0.95 (IQR, 0.87-0.99).

Conclusion

This large, multisite retrospective cohort study was the first to demonstrate adherence rates across several HSSPs and provided novel insights into rates and reasons for appropriate gaps in therapy.

New ordered phase in geometrically frustrated generalized XY model

Critical properties of a geometrically frustrated generalized XY model with antiferromagnetic (AFM) and third-order antinematic (AN3) couplings on a triangular lattice are studied by Monte Carlo simulation. It is found that such a generalization leads to a phase diagram consisting of three different quasi-long-range ordered (QLRO) phases. Compared to the model with the second-order antinematic (AN2) coupling, besides the AFM and AN3 phases which appear in the limits of relatively strong AFM and AN3 interactions, respectively, it includes an additional complex canted antiferromagnetic (CAFM) phase. It emerges at lower temperatures, wedged between the AFM and AN3 phases as a result of the competition between the AFM and the AN3 couplings, which is absent in the model with the AN2 coupling. The AFM-CAFM and AN3-CAFM phase transitions are concluded to belong to the weak Ising and weak three-state Potts universality classes, respectively. Additionally, all three QLRO phases also feature true LRO of the standard and generalized chiralities, which both vanish simultaneously at second-order phase transitions with non-Ising critical exponents and the critical temperatures slightly higher than the magnetic and nematic order-disorder transition temperatures.

Radiation-associated gliosarcoma

The authors report a case of radiation-associated intracerebral gliosarcoma with fibrosarcomatous predominance, arising at the site of a low-grade glioma treated 10 years previously. The features of this case conform to the accepted criteria for radiation-induced tumour, in that the tumour developed within the radiation field, differed dramatically in histologic features from the original tumour and did not develop until 10 years after treatment. Although such tumours are most uncommon, this case suggests that radiation-induced gliosarcoma should be considered in the differential diagnosis of recurrent mass at the site of a treated intracranial neoplasm.