Impact of a specialist respiratory pharmacist in the management of interstitial lung disease

Introduction: Medications prescribed for the management of interstitial lung disease (ILD) and idiopathic pulmonary fibrosis (IPF) are high risk and/or high cost. A specialist pharmacist was placed in an outpatient ILD clinic to manage all patients with ILD and IPF. Aims and objectives: This study aims to determine the impact of a specialist pharmacist in the management of ILD. We hypothesise that a pharmacist can have a significant positive impact on improving patient choice, patient understanding and adherence to therapy. Methods: On initiation of therapy, all patients were counselled on ILD, management options, monitoring and supply by the specialist pharmacist. All drug interactions were checked and deprescribing undertaken, where appropriate. Patients were reviewed on a regular basis to assess adherence to therapy, dose escalate, assess the incidence of adverse effects and manage where appropriate, undertake blood monitoring and supply of medications. Results: Over an 18 month period, an average of 125 patients were reviewed by the specialist pharmacist each month. There were a mean of 20 new referrals to initiate therapy per month. 116 interventions were undertaken by the specialist pharmacist, this included deprescribing of inappropriately prescribed medicines, managing interactions and adverse effects and ensuring appropriate doses were prescribed. Conclusions: This study demonstrates the vital role a specialist pharmacist plays in the ILD multidisciplinary team. The specialist pharmacist was able to undertake a number of significant interventions which may contribute to a low initial drop out rate and adherence to therapy.