Pulmonary arterial hypertension (PAH) is a rare, progressive condition in which the arteries in the lung become stiff, thickened or narrowed, making the heart work harder to pump blood through them.
According to the American Lung Association, about 500–1,000 cases are diagnosed in the United States each year. At Shields Health Solutions, we have launched a clinical management model for PAH to better manage symptoms, including fatigue, edema and shortness of breath, and improve quality of life. While there are treatments for PAH, including oral, inhaled and IV/subcutaneous drugs, and supportive therapies, such as diuretics, anticoagulants and pulmonary rehabilitation, there is no cure.
Specialty medications for PAH are among those that the Shields trade relations team seeks to identify long before they are approved, engaging with manufacturers to make sure our health system partners gain access. Ambrisentan and bosentan, two of the medications involved in this PAH clinical management model, are among the many drugs for which we have developed access pathways for our partners. (Read more about the Shields drug pipeline here.)
Our innovative clinical workflow model for improving PAH care—combining integrated clinical expertise with a focus on patient-reported outcomes (PROs)— has been implemented with three of our partners, UConn Health, UMass Memorial Health Care and Baystate Health. Our dedicated care team of PAH-trained clinical nurses and pharmacists and in-clinic pharmacy liaisons assists patients, beginning with new patient onboarding, and monitors patients’ clinical status in a variety of ways. Nurses and pharmacists work together to proactively mitigate drug-related side effects and drug interactions while screening for medication adherence and monitoring PAH-specific lab results to provide comprehensive patient care. For example, our clinicians monitor WHO NYHA Functional class, 6-minute walk distance and other parameters that allow assessment of a patient’s overall clinical status.
Tracking outcomes is a key component of the PAH program. Nurse clinicians use a standardized, validated assessment tool that measures patient-reported quality of life. This allows the nurse clinician to risk-stratify the patient based on disease severity and progression, and to ensure advanced care plans are acted upon for patients who report poor quality of life. Our team of nurses and pharmacists can work with the patient’s team of providers to adjust medications as needed, maintain quality of care for stable patients, escalate care and refer the patient to appropriate services to address concerns.
In addition to ambrisentan and bosentan—both specialty medications that require Risk Evaluation and Mitigation Strategy (REMS) protocols—the program follows patients prescribed two open-access drugs, sildenafil (Revatio™) and tadalafil (Adcirca™). For ambrisentan and bosentan, Shields provides crucial program support by handling manufacturer data reporting, REMS clinical compliance and REMS desktop audit support.
The Shields clinical analytics team will analyze data from the three initial program sites and share findings in the future.
Shields partners with more than 70 health systems across the country, working alongside teams at health system-owned specialty pharmacies that we help accelerate. We have been at the forefront of integrating high-performance specialty pharmacy into clinical, operational and financial models.
About the Authors
By Kerry Mello-Parker, PharmD, MBA, Director, Clinical Compliance, and Kristen Ditch, PharmD, BCCCP, Manager of Clinical Outcomes at Shields Health Solutions.
Shields Health Solutions is the premier specialty pharmacy accelerator health system leaders trust to elevate clinical, operational and financial performance.