AB0908-HPR SIGNED, SEALED, DELIVERED: PHARMACISTS ACHIEVING BETTER CARE CLOSER TO HOME IN RHEUMATOLOGY HIGH COST DRUG MANAGEMENT DURING THE COVID-19 PANDEMIC

Abstract

Background: The Pharmacy High Cost Drug (HCD) and Homecare (HC) team, based at a large acute teaching hospital consists of a range of skilled pharmacists, technicians and administrative staff. The team act as a HCD liaison between the hospital and commissioners, working closely with an expanding variety of specialist clinical teams to manage prescription processing for the following patient groups; HC: 2238; Hospital FP10: 1060; Outsourced Subsidiary Pharmacy Model: 41. HCD management, particularly immunosuppressive biologic therapies for complex rheumatology conditions such as rheumatoid arthritis, has been challenging during the Covid-19 pandemic. The inelasticity in demand for better care closer to home and a functional Integrated Care Records system has intensified, as many patients are now shielding/self-isolating at home.1 Frugal innovations have been key during this time -achieving value and simplicity in service re-design to deliver better patient care. Objectives: This review explores the support provided by the Pharmacy HCD and HC team to the rheumatology service since March 2020 to aid in service improvements during the pandemic. Methods: The Pharmacy HCD and HC team reviewed existing practice to better respond to the service changes required during the pandemic in regard to the following areas; identifying patients for Covid-19 shielding; responding to changes in HC service provision; communication with commissioners; remote staff working; reviewing HCD formulations and administration routes; changes in commissioning arrangements. Results: i) Rapid development of patient datasets following identification of 1,623 immunosuppressive drug entries in line with BSR Covid-19 guidance (first published in March 2020), thus enabling social distancing/shielding guidance to be issued to patients via letters/virtual platforms.2 ii) Swift re-routing of urgent new biologic HC registrants to a new hospital pharmacy home delivery provision when certain HC providers temporarily imposed restrictions on intake of new registrants. This hospital initiative was further enhanced to a hub and spoke model enabling patients to have easy access to their medications from their nominated local community pharmacy branch. iii) Providing assurance to commissioners that clinical follow up reviews could continue virtually, blood samples could be taken at an external hub and blueteq documentation would be completed covering NICE technology appraisal (TA) criteria. iv) A successful pilot utilising the lean PDSA (Plan, Do, Study, Act) quality improvement methodology, to enable remote working pharmacists and technicians to process HC prescriptions remotely in the absence of an electronic prescribing and medicines administration system. v) Reviewing potential plans to switch certain hospital day-case intravenous biosimilar infusions such as infliximab to subcutaneous administration via HC. vi) Business contingency development plans to protect fragile medication supply chains. vii) Clarifying implications for changes in contracting and payment arrangements announced by NHS England and NHS Improvement due to the pandemic.3 Conclusion: In summary, the role of the HCD Pharmacists during the pandemic in supporting rheumatology patients and the multidisciplinary team has been fundamental; ensuring signed prescriptions are securely processed to safely deliver medication to those in need.