In advance of Trellis Rx’s upcoming Expert Review of Recent Health System Specialty Pharmacy Research Studies webinar series, we’re sharing perspectives and takeaways from the pharmacist and pharmacy liaison investigators who will present their studies and findings.
Brandon Hardin serves as the director of clinical services at Trellis Rx. His research study investigated the impact of a clinic-embedded health system specialty pharmacy services team on patient-oriented eczema measure (POEM) scores in patients receiving treatment for atopic dermatitis. The study was co-authored with Trellis Rx Clinical Pharmacists Jessica Mourani and Lauren Skove, as well as Pfizer Medical Outcomes Specialist Heidi Luder who contributed to the project in the form of data analysis.
1. Why did you choose to investigate this topic?
Brandon: Treatment advances over the past few years have improved care for patients with atopic dermatitis, and patient expectations for treatment outcomes have changed as a result. Patient reported outcome measures (PROMs) like the POEM, a tool used for monitoring atopic dermatitis symptom severity, are specifically designed to capture information from the patient that other diagnostic tools such as physical exams and lab results cannot. PROMs have been available in the dermatology space for some time but have not been utilized to their full potential. With this study, we hoped to see how health system specialty pharmacists could impact outcomes for patients with atopic dermatitis by leveraging the POEM to enable proactive interventions and support.
Heidi: When I first learned about pharmacists being integrated into dermatology clinics, I was fascinated by this approach. I had never before seen pharmacists working so closely with dermatology providers to support patients. A quick literature search confirmed my suspicion that this was a truly innovative practice space for pharmacists. This led to discussions about what PROMs data pharmacists in dermatology clinics could capture using validated tools and how this data could be measured and tracked to determine the pharmacist’s impact on patient care.
2. In your opinion, what is the most interesting finding from your research?
Brandon: We were confident the study would demonstrate an improvement in POEM scores across the patient population, so to me the most interesting result was that 56.5% of patients moved from a more severe eczema category to a lower one. As a healthcare professional, I find this highly meaningful because it directly demonstrates how locally-embedded health system specialty pharmacy services can impact patient outcomes. Also, this data point indicates that health system specialty services enhanced care for the majority of patients, not just a small segment of patients who saw drastic improvements.
Heidi: The POEM is a validated PROMs tool consisting of 7 questions that measure the severity of atopic dermatitis symptoms, such as itching, bleeding, weeping/oozing, cracking, flaking, and dryness/roughness of the skin, and their impact on a patient’s quality of life. It is scored on a scale of 0 to 28, with a lower score indicating less severe disease activity. In the study, the average patient score at baseline was 10.47, which indicated moderate symptoms. After patients were enrolled in specialty pharmacy services, the average patient score declined to 4.89. I think it’s important to note that prior to enrollment in specialty pharmacy services, there was still an unmet need for controlling patients’ symptoms and the specialty pharmacy team had an important role in helping to manage these patients.
3. How does this study advance the health system specialty pharmacy practice?
Brandon: Seeing the quantifiable impact and improvement across the patient population in the study is extremely rewarding. This serves to validate our high-touch clinical model by demonstrating the positive impact that our health system partners are having on clinical outcomes, and more specifically, on PROMs.
Heidi: Specialty pharmacists are important members of the healthcare team and help to manage complex medications for complex conditions. This project showcases a unique way for specialty pharmacists to integrate into the care team, gain the patient perspective, and help to manage complex medical conditions. This project could be easily replicated, not only in dermatology, but other specialty conditions.
4. How do you hope your findings are used by other pharmacists or pharmacy liaisons?
Brandon: I hope it encourages other pharmacists and pharmacy liaisons supporting dermatology patients to incorporate PROMs into their clinical protocols for atopic dermatitis. More broadly, I hope it encourages health system pharmacists and pharmacy liaisons across specialty areas to explore how they can leverage PROMs, even with patient populations where PROMs haven’t been widely used historically. We have a unique opportunity to drive greater adoption of these tools, and given our access to patients and providers, we are strongly positioned to leverage patient-reported data to drive proactive care and interventions that help improve outcomes.
Heidi: I think there are many opportunities for pharmacists to integrate validated tools into their practice. The POEM is just one example. There are other tools available for atopic dermatitis and other dermatological conditions, and for pharmacists that don’t work in dermatology, there are many similar tools available for other disease states. Integrating these patient-reported outcome tools helps to measure and track patient outcomes. These tools can provide additional data to help gain the patient’s perspective and involve the patients in their own care. I think this work can inspire other pharmacists to collect and measure patient-reported outcomes and share their work through posters and publications.
5. What advice would you offer other pharmacists who are interested in conducting research studies?
Brandon: Don’t be afraid to investigate topics haven’t been studied or published before. It has been my experience that pharmacists know their patients and know what pharmacy services make a difference in their patients’ lives. Research studies are about proving the value of our activities and interventions to others that don’t see the impact directly every day like we do.
Heidi: Research doesn’t need to be complicated. Randomized clinical trials are not the only type of research. Quality improvement and retrospective projects, for example, also provide valuable information. It can be as simple as measuring what you are already doing in a systematic way. Practice-based research is important because it helps pharmacists to measure their impact on patient outcomes, demonstrate value, and advance the practice of pharmacy.