High safety screening rates prior to immunomodulator initiation at health-system specialty pharmacies: A multisite, prospective, observational cohort study

PURPOSE: Patients being initiated on treatment with select immunomodulators should be screened for tuberculosis (TB) and hepatitis B virus (HBV). Previous studies found disparities in TB/HBV screening before therapy initiation. Health-system specialty pharmacies (HSSPs) have access to electronic health records and can evaluate infection screening completion. SUMMARY: A multisite, prospective, observational cohort study was conducted at 12 HSSPs. Patients 18 years of age or older prescribed an immunomodulator between March 1 and May 31, 2023, were included. Patients prescribed medications associated with a risk of TB or HBV reactivation within the previous year or referred from a non-health-system provider were excluded. Patients were followed for 6 months. Screening completion was summarized as percentages. Univariate logistic regression models were used to evaluate the association between the number of HSSP services provided and completion of safety screening, and safety screening-related pharmacist interventions. Of 1,597 pharmacy referrals, 737 patients were included. Patients had rheumatological (55.5%; n = 409), dermatological (29%; n = 214), or gastroenterological conditions (15.5%; n = 114). In total, 95.1% of patients (n = 701) had any screening for TB and HBV, and 81.5% (n = 601) completed screenings within 2 years before or 60 days after referral. Screening was completed within 1 year before or 60 days after referral for 75.3% of patients (n = 555). More HSSP services were associated with increased likelihood of completed safety screening (odds ratio [OR], 1.23; P = 0.012) and pharmacist interventions (OR, 2.68; P = 0.04). CONCLUSION: High rates of screening for TB and HBV before immunomodulator therapy initiation were observed in patients referred to HSSPs.