Management of multiple sclerosis and the integration of related specialty pharmacy programs within health systems.

PURPOSE: The management of multiple sclerosis (MS) and the integration of related specialty pharmacy programs within health systems are discussed. SUMMARY: MS is a progressive immune-mediated inflammatory disease of the central nervous system. Current treatment strategies include the use of disease-modifying therapies (DMTs) that have various degrees of efficacy and tolerability. These DMTs also differ with respect to frequency and route of administration, which can significantly impact patient compliance and ultimately their response to therapy. The introduction of oral and injectable DMTs requiring less-frequent injections and having better adverse-effect profiles may help patients improve adherence to therapy; however, access to these therapies is often restricted due to both their high cost and limited distribution. These DMTs include fingolimod, teriflunomide, dimethyl fumarate, and pegylated interferon beta-1a. All others, with the exception of fingolimod, have limited distribution. Pharmacists in health-system pharmacy programs can play a significant role in assisting patients with MS manage their disease efficiently and safely by educating them about their therapies, ensuring compliance with the associated risk evaluation and mitigation strategy (REMS) program, and helping them access these therapies in a timely manner. CONCLUSION: MS is a progressive neurologic disorder that requires lifelong treatment with DMTs. Good compliance, compliance with the associated REMS program, and timely access to these drugs may positively influence patient care and outcomes and provide an opportunity for the health-system pharmacists to have a active role in caring for these patients.

Patient adherence to three dose completion of the quadrivalent human papillomavirus (HPV) vaccine in a private practice.

The human papillomavirus quadrivalent (types 6, 11, 16, and 18) recombinant vaccine is effective in preventing cervical, vulvar, vaginal and anal cancer. Maximal protection is achieved with completion of all three recommended doses. A retrospective chart review was performed to (1) assess the current vaccine series completion rates in a private practice multispecialty suburban setting and (2) identify factors associated with failure to complete the vaccine series. Chi-square and independent samples t test were used for data analysis. A total of 4,117 patients out of 10,821 eligible patients received at least one dose of the HPV vaccine between October 1, 2006 and April 30, 2010. Overall, 69.5 % (n = 2,863) of patients who received one dose of the HPV vaccine completed all three doses in a valid time frame, representing 26.5 % of all eligible patients. Patients who completed the series were younger (16.8 vs. 18.2, p < 0.05), less likely to have a sexually transmitted disease diagnosis prior to initiation of the series (57.7 vs. 69.8 %, p < 0.05), and more likely to have visited the pediatrics department compared to family medicine, internal medicine, and OB/GYN departments (75.9, 65.7, 57.0, 60.9 %, respectively, p < 0.05). Deaths, pregnancies, and adverse drug reactions were not identified as independent factors impacting completion rates. The results indicate that adolescents, patients visiting the pediatrics department and those without a prior STD diagnosis completed the vaccination series more frequently than adults managed in family medicine, internal medicine, and OB/GYN departments.