Establishing Workflow for In-clinic, Home Administration of Cabotegravir-rilpivirine Injections for HIV-1

The development and operationalization of the workflow within both the clinic and the pharmacy are critical to properly implement a new and novel medication therapy, such as cabotegravir-rilpivirine, for patient initiation and management during treatment, according to a poster presentation at the American Society of Health-System Pharmacists (ASHP) Specialty Pharmacy Conference.

A long-acting monthly intramuscular injection, cabotegravir-rilpivirine was recently approved by the FDA for the treatment of HIV type-1 (HIV-1) and is the first injectable approved by the FDA for the treatment of this disease type. Additionally, the therapy needs to be administered by a health care professional either in the patient’s home or at the clinic.

To appropriately facilitate patient access to this novel therapy, it is necessary to address the specific clinical and operational barriers present. To address these challenges, Yale New Haven Hospital (YNHH) took a pharmacist-led approach in developing a workflow that supports patient education, medication ordering, and administration. Despite being administrative in nature, a streamlined workflow could directly improve patient satisfaction, clinician workload, and the prescription capture rate for the health system’s overall integrated specialty pharmacy, according to the researchers.

At the YNHH Department of Pharmacy Services, officials developed a workflow to efficiently initiate and manage patients on cabotegravir-rilpivirine. Feedback on the rollout of the process was then provided by medical and nursing leadership within the clinics before the workflow structure was fully implemented.

Collaborating directly with the health system’s integrated specialty pharmacy and outside insurance carriers, the embedded ambulatory care pharmacist worked to ensure the medication would be accessible to patients regardless of where the therapy was administered, such as in the clinic through a medical benefit or through prescription insurance coverage for at-home administration.

Additionally, pharmacy administration, the finance team, and information technology team provided the necessary information on the medications for the electronic health record (EHR) to ensure proper billing, ordering, and documentation.

To meet the needs of patients receiving the therapy in both the clinic and at home, 2 workflows were developed that included input from the embedded pharmacist and clinic prescribers so that they could effectively identify patients who were interested in changing their antiretroviral regimen to cabotegravir-rilpivirine.

The newly established workflows sought to address patient education, patient tracking, how medication orders and prescriptions were entered by the ambulatory clinic pharmacist embedded in the clinic, as well as how pre-existing specialty pharmacy services would be used for the new therapy, such as through the use of benefits verification and a medication assistance program.

Furthermore, officials identified areas within the workflow that were in need of technological advancement, such as the process of entering the EHR and computerized physician orders, billing codes, and automated patient reports.

Overall, the new workflow process was designed to ensure clinicians, the embedded pharmacist, and specialty pharmacy team members could collaborate effectively in the tracking of patient progress, patient adherence to monthly injections, and patients’ experience of financial barriers.

In the future, the study authors noted that further assessments would address the success of workflow efficiencies and patient and provider satisfaction, as well as revenue generation for the health system.

REFERENCE

Vuernick E, Tong K, Luon S, Stutsky M, Boothe K. Operationalizing a Workflow for In-clinic and Home Administration of Cabotegravir-rilpivirine Monthly Injections for HIV. Poster presented at: 2021 ASHP Specialty Pharmacy Conference; virtual. https://www.eventscribe.net/2021/SpecialtyPharmacy/PosterTitles.asp?pfp=BrowsebyTitle. Accessed July 27, 2021.