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The Role of Clinical Pharmacists in Neurology: Focus on Neuroimmunology and Multiple Sclerosis Care
Key Takeaways
- Clinical pharmacists enhance neurology practices by improving medication access, adherence, and patient education, particularly in neuro-immunology and neuromuscular clinics.
- They manage complex medication regimens, mitigate polypharmacy risks, and contribute to medical research, ensuring safe and effective patient care.
Kiranpal Singh Sangha, PharmD, clinical pharmacy specialist and adjunct assistant professor of pharmacy at The University of Cincinnati, talked about the vital role of clinical pharmacists in neurology, specifically in multiple sclerosis care.
Kiranpal Singh Sangha, PharmD
(Credit: National MS Society)
Clinical pharmacists are becoming an essential part of neurology practices, bringing specialized training and expertise to support both providers and patients in navigating the increasingly complex landscape of treatment options. Over the past 30 years, the number of therapies available for neuro-immunologic (NI) conditions has grown significantly. However, many of these therapies are complex, both in clinical use and in trying to navigate the intricate systems of insurance coverage and financial reimbursement.
Pharmacists are uniquely equipped to address these challenges and help ensure access to these advanced therapies. A recent study demonstrated that involving pharmacists in neuro-immunology and neuromuscular clinics led to statistically significant improvements in medication access compared to the time before pharmacist involvement1. Their contributions included streamlining prior authorization approvals, providing detailed drug information, and serving as medical liaisons. Beyond facilitating access, pharmacists played a crucial role in educating patients about their medications, supporting treatment adherence, and monitoring outcomes.
As the range of treatment options continues to expand, the expertise of clinical pharmacists will remain invaluable in optimizing care for patients with neurologic conditions. Many disease-modifying therapies (DMTs) for neuroimmunologic (NI) conditions, such as multiple sclerosis (MS), come with significant risks, complex dosing regimens, strict monitoring requirements, and high costs, often necessitating management through specialty pharmacies. Some of these treatments are administered via intravenous (IV) infusion and require oversight at specialized healthcare facilities.
Patients with neurologic diseases, including MS, often experience a combination of visible and invisible symptoms. Research shows that MS DMTs can reduce relapse activity, delay progression of disability and limit new inflammation in the central nervous system. However, this progress can come with additional challenges due to coexisting conditions. Pharmacists play a crucial role in helping patients navigate these complexities. Their expertise enables them to manage complex medication regimens, minimize risks like drug-drug interactions, drug-disease interactions, therapeutic duplications, and address potential adverse effects, ensuring patients receive safe and effective care.
Polypharmacy presents a significant challenge for patients with neurological diseases. While definitions of polypharmacy vary, one author defines it as the use of more than five daily medications2. A review estimates that polypharmacy affects 14% to 76.5% of patients with MS and over 50% of adults aged 65 and older. Polypharmacy can lead to serious health risks, including falls, hypotension, bleeding, and organ dysfunction, such as impairments in brain and kidney function. Pharmacists are uniquely positioned to mitigate these risks by conducting thorough medication reviews, ensuring accurate and comprehensive medication records, and assisting in deprescribing efforts to reduce adverse health outcomes.
Pharmacists also play a critical role in medical research. Their contributions include serving as investigators, educating patients, managing research protocols, and dispensing medications for clinical trials. The growing complexity of therapies for neurologic conditions and the intricate studies required to evaluate them make the expertise of pharmacist’s indispensable for conducting effective and reliable research.
The Broader Role of Pharmacists in Neurology
Pharmacists are indispensable in the care of patients with neurological conditions. They optimize treatment plans, prevent adverse drug events, and support shared decision making3. Oftentimes, pharmacists in the clinic setting will have collaborative practice agreements with providers. This allows pharmacists to collaborate with providers and the entire healthcare team which may include nurses, advanced providers, social workers, dietitians, business, financial or medication access and allied health staff. By spending more time with providers, patients are likely to have an earlier diagnosis for their condition. This can lead to earlier treatment which has a positive impact on the journey of an individual living with MS. In addition, pharmacist roles extend beyond medication management to include patient and family education, completing insurance-required prior authorizations, and liaising with medication manufacturers and payors to secure necessary treatments. These efforts alleviate significant burdens on the healthcare team, ultimately improving outcomes for both patients and providers in multidisciplinary care settings.
