Investigator Insights: Impact of Pharmacist Interventions on Alignment with ACR COVID Vaccine Guidance

Published 10/25/2021
by Kathryn Edwards

During American Pharmacists Month, we’re sharing perspectives and take-aways from the pharmacist and pharmacy liaison investigators who presented their research studies and findings in our recent “Expert Review of Recent Health System Specialty Pharmacy Research Studies” webinar.

Sarah Reagin, RPh, CSP, and Logan Franke, PharmD, CSP, serve as specialty pharmacists in the rheumatology clinic at a health system in Indiana. Their research study investigated the impact of pharmacist interventions on patient alignment with the American College of Rheumatology or ACR COVID vaccine guidance on timing considerations for disease-modifying antirheumatic drugs (DMARDs) and COVID-19 vaccinations. Their study found that pharmacist interventions prevented 3 of every 5 patients from inappropriately continuing or holding therapy, while also driving patients who initially refused vaccination to get vaccinated.

Want to learn more? Watch the on-demand version of our recent CE webinar or click the image below to view Sarah and Logan’s poster presentation.

  1. Why did you choose to investigate this topic?
    Sarah: The COVID-19 pandemic has been top-of-mind for every healthcare provider, and as a pharmacist I was asking, “What is my role in slowing the spread?” Early on, we seized the opportunity to partner with rheumatology providers to help educate patients in our clinic about COVID-19 vaccines. During our medication counseling sessions, we would review the American College of Rheumatology’s recommendations for adherence around vaccinations and address patients’ concerns and questions. We wanted to measure the impact of our interventions on adherence and vaccination rates through a research study.Logan: Over the past year, COVID-19 was among the most discussed topics in our clinic, just as it has been everywhere in the world. At the start of the pandemic, there were a lot of questions surrounding if patients should be on biologic DMARDs due to their immunosuppressive nature. Before the ACR COVID vaccine guidance was released that most patients should continue treatment, there was significant divergence in the rheumatology community on the subject. The same was true about the COVID-19 vaccine when it was initially made available. The American College of Rheumatology released guidance around timing considerations for DMARDS and vaccinations in March 2021. However, the guidelines are not particularly easy to interpret and vary based on which drugs patients are using. As pharmacists, we saw an opportunity to intervene to ensure patients consistently received guidelines-based counseling about continuing or holding their therapy when they received the vaccine. Conducting a research study to evaluate the impact of our interventions seemed like a natural next step.
  2. In your opinion, what is the most interesting finding from your research?
    Sarah: What I found most interesting was the level of misunderstanding among patients, even after the American College of Rheumatology guidelines were published. As pharmacists, we had a unique opportunity to address confusion and misinformation, which ultimately helped more patients in our clinic choose to get vaccinated and ensured patients continued or held their therapies appropriately when they received the vaccine.Logan: Our study measured if patients would have been aligned with the ACR COVID vaccine guidance and timing considerations for DMARDS and vaccinations in March 2021. We found that, without our interventions, 60 percent of patients – of 3 of every 5 patients – would have either continued therapy inappropriately or held therapy inappropriately when they received the vaccine. I found these numbers staggering. Without pharmacist interventions, these patients would have either had less protection from their vaccine or risked disease flares due to inappropriate holding of doses.
  3. How does this study advance the health system specialty pharmacy practice?
    Sarah: This study directly demonstrates the impact pharmacist education and interventions can have on patient outcomes. In particular, our research shows the value of integrating pharmacists into specialty care teams at health systems. I hope other health systems will consider offering specialty pharmacy services or empowering their current specialty pharmacists to practice at the top of their profession to enhance patient care and outcomes.

    As health system specialty pharmacists, we are uniquely positioned to partner with physicians to make a clinical impact as close to real time as possible. Working in clinics, we have access to do a consultation with patients immediately following an appointment or medication change. Speeding the time between physician visits and pharmacy interactions allows us to clarify or reinforce information before events occur that could potentially have a negative impact on patient outcomes.
  4. How do you hope your findings are used by other pharmacists or pharmacy liaisons?
    Sarah: I hope pharmacists across all settings will be encouraged to measure the impact of their services on patient outcomes. I also hope our findings will inspire other health system specialty pharmacists to seek out similar opportunities to impact patients in their clinics. With booster vaccinations now available, the role of education will remain critical in the rheumatology space and other specialty areas.Logan: Our findings serve as a reminder that pharmacists and pharmacy liaisons are respected and trusted care team members – and that what we tell patients has an impact. Using an evidence-based approach when educating patients is always best, especially when guidelines are available. Finally, our research revealed that it is common for there to be a delay in  providers adjusting their practice when new guidelines are published. Our findings show how pharmacists can assist in accelerating this transition and enhancing patient outcomes.
  5. What advice would you offer other pharmacists who are interested in conducting research studies?
    Sarah: Prior to completing this research study, I felt that advising and counseling patients was part of my job, not something to be researched. However, the opportunity to investigate the impact of my services on  patient outcomes was incredibly rewarding. My advice would be to never doubt the importance of your role in patient counseling and education. When considering your own research study ideas, remember that every interaction you have can make a measurable impact.Logan: If you are interested in conducting research studies, consider starting small. What is something you do frequently that you believe has an impact on your patient? What data will you need to capture – and how will you capture it? Your project may begin as a small idea that grows into a very impactful study as you move along. Don’t be afraid to get started with some “low-hanging fruit.”

Want to learn more? Watch the on-demand version of our recent CE webinar or click the image below to view Sarah and Logan’s poster.