A Descriptive Study of a Clinical Pharmacist’s Role in the Outpatient Pulmonary Hypertension Clinic in the United States (CliPR-PH)

BACKGROUND Pulmonary arterial hypertension (PAH) is a rare disease affecting the heart and lungs. Median survival was 2.8 years historically, but prognosis improved with the advances of PAH therapy. It is currently not standard of care for clinical pharmacists to be a part of the interdisciplinary care team in outpatient PH clinics to help manage patients’ drug regimens, and there is limited literature that has explored the impact of clinical pharmacists on patient-related processes and outcomes. The goal of the CliPR-PH study is to characterize the activities of the clinical pharmacist as a member of the interdisciplinary team. METHODS CliPR-PH was a retrospective, descriptive, single-center cohort study of patients ≥ 18 years, diagnosed with pulmonary hypertension, and managed by a clinical pharmacist practicing under a collaborative practice agreement between January 1, 2018 and July 31, 2020. Patients were excluded from the study if they were not on any PAH medications at the time of pharmacist encounter. RESULTS Sixty patients were included in the analysis and 331 clinical pharmacist interventions were documented over the study period. Interventions were regarding selexipag [88 (26.6%)], sildenafil [74 (22.4%)], tadalafil [46 (13.9%)], prior authorization (PA) completions [127 (38.4%), PA troubleshooting [43 (13.0%)], and ‘Other’ [49 (14.8%)]. CONCLUSION Clinical pharmacists can play an important role in closely monitoring patients during the medication titration phase and ensure prior authorizations are approved in a timely manner as part of the interdisciplinary team in the outpatient PH clinic setting using a collaborative practice model approach. Clinical Perspective What is new? There are currently no studies in the United States that asses a clinical pharmacist’s role on the interdisciplinary team as part of a collaborative practice agreement in the outpatient pulmonary hypertension (PH) clinic. What are the clinical implications? Integrating a clinical pharmacist on the medical team in an outpatient PH clinic setting allows them to closely monitor patients who are titrating selexipag, manage adverse events (AEs) that occur during the titration phase, and ensure medications requiring prior authorizations are approved in a timely manner. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement WCG IRB was funded by University of California, San Francisco's Department of Clinical Pharmacy. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: IRB of WCG waived ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data is encrypted in an Excel sheet within the UCSF server.