Ms Heidi Wong1, Ms Elouise Middlemiss1
1Children’s Health Queensland, Brisbane, Australia
Background: Orkambi® is a potentially life-changing medicine for patients over six years of age who have two copies of the f508del mutation in the CFTR gene. The medication has been shown to improve lung function and BMI, and reduce pulmonary exacerbations by up to 40%. Orkambi® was introduced on the Pharmaceutical Benefits Scheme (PBS) on 1st October 2018 and it is only available via hospital pharmacy. Prescribers are required to provide an extensive list of documentation to fulfil PBS authority restrictions. Being a strong enzyme inducer, Orkambi® has very high potential to cause many drug interactions; many of which are not well documented.
Method: Cystic Fibrosis Service identified 200 patients (both local and regional) currently under their care as eligible. We approached these families to undertake comprehensive medication history; with the aim to identify potential drug interactions and other medication related problems, formulate pharmaceutical care plans, and provide medication counselling. The number of service occasions, drug interactions identified and drugs involved were recorded for analysis.
Result: Between October 2018 and January 2019, we completed 120 comprehensive medication histories and 91 medication counselling sessions via face-to-face discussion at CF clinics, telephone and telehealth channels. Twenty-nine significant drug interactions (Orkambi vs drug or patient or condition) were identified, among which 55% were with prescription-only medications, 35% were with over-the-counter or complementary medicines and 10% were with medical issues (e.g. impaired liver function). Upon review, we found that medication histories taken by non-pharmacy staff were mostly incomplete (particularly with respect to complementary medicines) or without a documented plan to manage the impact of identified drug interaction. The feedback from families and CF team on this pharmacy service was very positive; they appreciated the opportunity to speak to a pharmacist and asked many questions unrelated to Orkambi®.
Discussion: Pharmacists have expertise in medication management.In this case of Orkambi® initiation, we helped streamlining the PBS authority application process by undertaking comprehensive medication histories. We kept our patients safe by identifying and managing potential drug interactions. We improved family experience by being proactive and empowering. Our value in patient care has been realised.
Heidi currently works as the pharmacist medical lead at Queensland Children’s Hospital. She has over 15 years’ experience in paediatrics and represents paediatric pharmacists at statewide and national forums. Her research interests include general paediatrics, professional education and training, paediatric medicines and system improvements.