Abstract
Background: Lactulose non-adherence has been identified as a factor for recurrent episodes of hepatic encephalopathy (HE). Treatment guidelines recommend adding rifaximin (Xifaxan
1
) to lactulose for ongoing management after an overt HE recurrence on lactulose alone to reduce the risk of further episodes and HE-related hospitalizations. Clinical observations suggested that rifaximin therapy is not initiated in patients upon HE-related hospital discharge where indicated.
Aims: Integrate the CHI Health Specialty Pharmacy medication access coordinator (MAC) into the cascade of care of patients during an HE-related hospitalization to optimize access to and initiation of rifaximin upon discharge.
Methods: Retrospective assessment of integrated MAC assistance in the CHI Health gastroenterology clinic from 26 September 2018 to 31 March 2019. Hospitalized patients were identified using TheraDoc
2
reporting. Inclusion criteria: rifaximin ordered during an HE-related hospital admission at CHI Health. Exclusion criteria: discharge care assignment to an alternative physician group or facility. Primary outcome: the percentage of patients initiated on rifaximin upon hospital discharge via the integrated MAC. Secondary outcomes: cases requiring benefits verification and financial assistance, and number of rifaximin prescriptions acquired by the CHI Health Specialty Pharmacy.
Results: A total of 40 patients met the inclusion criteria during the assessed timeframe. Thirty-one patients were excluded, 27 to other groups and 4 to facilities. Integrated MAC assistance was utilized for the remaining 9 patients and 100% were initiated on rifaximin upon discharge. Of those, 4 required benefits prior authorizations, 2 qualified for manufacturer patient assistance and 3 received sample medication. CHI Health Specialty Pharmacy acquired 2 rifaximin prescriptions.
Conclusions: Integrated MAC assistance in a health-system gastroenterology clinic optimizes rifaximin access and initiation in patients following an HE-related hospitalization. It is anticipated that more patients going forward will qualify for MAC assistance due to a reduction in the community physician groups providing care at CHI Health. Further evaluation is warranted to determine whether medication optimization results in improved adherence and reduced readmissions in this population.