Louise Grech

Development and validation of RhMAT, as medication assessment tool specifically designed for rheumatoid arthritis management

The implementation of individualised pharmaceutical care plans based on the identification of pharmaceutical care issues for rheumatoid arthritis patients presenting at outpatient clinic service has been proven to be effective in improving the quality of life of these patients. However, the identification and classification of pharmaceutical care issues into drug therapy problems does not give room to assessment of prescribing trends and adherence to international guidelines. The novel concept of medication assessment tools, is a concept which integrates pharmaceutical care issues within a larger context, that of evaluating the prescribing trends. The objective of this research was to design, and validate medication assessment tools specifically for rheumatoid arthritis patients.

Preparing for pharmacist prescribing in Maltese hospitals

To develop and evaluate a framework for pharmacist prescribing in a hospital setting, assess differences between pharmacist and physician prescribing and analyse pharmacist perceptions on pharmacist prescribing.

CP-185 An innovative treatment adherence tool

Background Non-adherence in heart failure leads to hospital admissions and fatalities. The Morisky scale may be adequate in some clinical scenarios, yet the score is selected by balancing sensitivity and positive predictive values.1 Purpose To measure treatment adherence using a novel model that achieves a good outcome in pharmaceutical care. Material and methods The questionnaire was developed and validated in Maltese ‘Kwestjonarju ghall-Uzu tal-Medicina u l-pazjent’ (KUMP) and forward translated into English ‘Treatment adherence questionnaire’ (TAQ). The tool is a 13 item questionnaire with the last question embedding 7 sub-questions on various non-adherence scenarios. The questions tackle knowledge, patient self-care, access, communication and appropriate medicine use with six possible answer categories from ‘never’ to ‘always’. Scoring for parts A and B is different, to facilitate understanding of all of the questions by the individual respondent with a maximum score of 100. A higher score indicates higher adherence. Results The questionnaire’s good content coverage and acceptable item properties resulted in positive expert review ratings with a high reliability score (Κ=0.89; p<0.05). The tool was used to interview 50 heart failure patients (44–93 years). The mean score was 66% (n=50; SD=10) with the highest and lowest scores being 89 and 40, respectively. Only 4 patients (n=50) answered that they were never entitled to free medicines, attaining low adherence scores. 3 of the 46 patients admitted that they were confused with their prescribed medicines and needed a follow-up to organise their treatment charts for a smooth discharge. 2 of the 46 patients were buying other related medicines. 5 patients (n=50) confirmed that they had stopped taking a particular medicine, with 3 being readmitted due to such incidents. Conclusion The mean adherence score of the studied heart failure population sample indicated moderate adherence. Dichotomous questions do not allow the outcome of the appropriate answer since there are grey areas that cannot be captured. Therefore, the novel tool provided more insight and was simple and practical to use. The tool can be applied to other clinical scenarios. References and/or acknowledgements Shalansky SJ, Levy AR, Ignaszewski AP. Self-reported Morisky score for identifying nonadherence with cardiovascular medications. Ann Pharmacother2004;38:1363–8. No conflict of interest

Pharmacotherapy of Rheumatoid Arthritis

Panacea, or Panakeia, was the Greek goddess of healing and was attributed to have a potion that cures all illnesses and diseases. Being the daughter of Asclepius, son of Apollo and god of medicine, she was venerated in the temple dedicated to Asclepius, in Epidaurus in the northeast of the beautiful Peloponnese. She is also mentioned in the original Hippocratic oath where the physician swears by a number of gods to serve the patients to the best of one’s abilities. Although the quest for a universal cure, an elixir of life, or the holy grail of medicine remains a mythological fictional aspect, medicine has made great progress when it comes to the drug armamentarium available for rheumatoid arthritis. This chapter puts forward the pharmacological management of rheumatoid arthritis starting with a look at the past.

Pharmaceutical Care Issues of Rheumatoid Arthritis Patients

Along the years, pharmacy as a profession has come a long way. It has grown from the traditional role of the pharmacist-compounder, preparing and dispensing extemporaneous preparations within community pharmacies, to the role of the pharmacist dispensing ready-made medicines within community pharmacies [1–6]. This move from product focus to patient focus brought to the forefront the pharmacist intervention as an advisor and coordinator of care. The profession has expanded also within the pharmaceutical industry where pharmacists contribute at various levels within the pharmaceutical industry ranging from research and development for innovative drugs, quality control to pharmacovigilance and pharmaceutical regulatory affairs personnel. The pharmacy profession has made major strides within the hospital setting with clinical pharmacists participating as the fulcrum of a multidisciplinary team and contributing to the decision-making for patient care. In this evolution of the pharmacy profession, the patient’s well-being is the focus of pharmacist’s activities in whichever setting they are practising, and this is what makes a pharmacist a unique player in the different settings.

AB1205 Development of Rheumatology Shared Care Guidelines: Improving Seamless Care Between Hospital and Community Settings

Background Shared care guidelines (SCGs) assist healthcare professionals and patients in clinical decision making, allowing the seamless transfer of patient treatment, management, and pharmaceutical care. In Malta, rheumatology patients pick up their chronic medication supply free of charge from a community pharmacy of their choice. It is important that the community pharmacist is aware of the plan by the caring rheumatology team within the public NHS hospital. SCGs enable for improved communication and coordination between primary and secondary settings. Objectives The aim of the studywas to develop Shared Care Guidelines for rheumatology drugs with an emphasis on the communication between pharmacists within the hospital setting and the pharmacists within a community setting. Methods A list of rheumatology drugs requiring the development of Shared Care Guidelines (SCG) was compiled. A literature review on the importance, relevance of SCGs and already existing foreign and local SCGs was carried out in order to design the optimal Maltese Rheumatology Shared Care Guideline (MRSCG) template. A draft MRSCG for Infliximab was compiled and evaluated by an expert panel consisting of a consultant rheumatologist, specialised rheumatology nurse, a rheumatology clinical pharmacist and a community pharmacist. Results An important parameter established during the design of the Shared Care Guidelines was Pharmacist Intervention. The expert panel all agreed that the community pharmacist who is dispensing the rheumatology medications has become part of the extended healthcare team. All members agreed that the role of the rheumatology clinical pharmacist in hospital was well established but the role of the community pharmacist should be strengthened and communication with the community pharmacists should be improved. The first compiled MRSCG on Infliximab consists of 3 main sections. Section A outlines pharmacological background on infliximab, the associated responsibilities of the medical rheumatology team, the rheumatology nurse specialist, the clinical pharmacist, the community pharmacist and the general practitioner. Section B consists of the patient management care. This section incorporates reconstitution guidelines, and documentation of the dose and the pre-infusion monitoring parameters required together with signatures of the respective health care professional carrying out the reconstitution, the monitoring of the patient and administration of the drug on day of infusion. Section C contains referral checklist sent by the medical team to the general practitioner and referral checklist sent by the hospital clinical pharmacist to the community pharmacist at initiation of treatment. All members of the panel agreed that the draft MRSCG for Infliximab was effective in outlining and documenting responsibilities and sharing of patient care between different settings. Conclusions For a shared care system to be achieved, communication between healthcare professionals in the different health sectors is of vital importance to ensure effective, rational and safe patient management. Disclosure of Interest None declared

AB1186-HPR Compiling and Evaluating Evidence-Based Algorithms for the Monitoring of Rheumatoid Arthritis Patients Receiving Disease Modifying Antirheumatic Drugs and Biological Agents

Background Pharmacological management of rheumatoid arthritis patients is based on the use of complex drugs such as disease modifying anti-rheumatic drugs (DMARDs) and innovative biological agents. Safe use of these drugs involves close and effective monitoring resulting in efficient risk management and improved quality of care provided to patients. Objectives The objectives of the study were to compile and evaluate algorithms intended to illustrate a stepwise approach in the monitoring required when prescribing and administering DMARDs and biological agents to rheumatoid arthritis patients. Methods A literature review was carried out to assess the current international guidelines on monitoring of DMARDs and biological agents. Interviews were carried out with two consultant rheumatologists as to the practice trends of monitoring. Draft algorithms were compiled and submitted for expert panel review. The expert panel consisting of ten members assessed applicability of the algorithms to the practical scenario, presentation, robustness and validity of the data provided. The final RhMonitoring Algorithms were compiled taking into account feedback proposed by the expert panel. Results Algorithms for the 5 most commonly used DMARDs (methotrexate, hydroxychloroquine, sulphasalazine, leflunomide, sodium aurothiomalate) and the locally currently available biological agents, etanercept, adalimumab, infliximab and rituximab were compiled. The expert panel consisted of a consultant rheumatologist, a rheumatology resident trainee, two research and academic pharmacists, a risk management pharmacist, a quality assurance pharmacist, a rheumatology nurse specialist, two medical doctors and a staff nurse. Response rate was 80%. All agreed that the algorithms are easy to follow, well laid out and practical. Three members commented that cautions and contraindications should be included alongside each respective algorithm to highlight these issues. Conclusions The developed RhMonitoring Algorithms present in a simplified manner the complex information on the monitoring frequency of DMARDs and biological agents. They also serve to standardise the monitoring plans required with these drugs in order across an interdisciplinary team so as to increase the level of patient care and service development. Acknowledgements The research group would like to acknowledge the members of the expert panel. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4880