OBJECTIVES: Prior studies have demonstrated that rifaximin may improve hepatic encephalopathy (HE) outcomes. However, high costs and prior authorizations often create patient access barriers for rifaximin. Specialty pharmacists have been shown to promote patient care by optimizing medication access. This study aims to evaluate the effect of a clinic-embedded GI specialty pharmacist on healthcare resource utilization (HCRU) and disease management in patients receiving rifaximin.

METHODS: A retrospective chart review was conducted to identify HE-diagnosed patients via ICD-9/10 codes. Patients were included if they were ≥18 years and were newly started on rifaximin at one of three GI clinics between July 1, 2015 – December 31, 2021. Patients were grouped based on rifaximin initiation date; one group included patients who started rifaximin prior to the initiation of clinic-embedded pharmacists, while the other group initiated therapy afterwards. The primary endpoint was all-cause HCRU indicated by emergency department (ED) visits and hospitalizations. Secondary outcomes included mortality and change in Model for End-Stage Liver Disease (MELD) score. Data was analyzed using chi-square test and Mann-Whitney U test.

RESULTS: Of 362 patients, 294 were treated in the pre-pharmacist group. 46.3% of patients had ≥1 ED visit within 6 months of rifaximin order in the pre-pharmacist group, compared to 45.6% in the post-pharmacist group (p=0.99). Additionally, 39.8% of patients in the pre-pharmacist group had ≥1 hospitalization, compared to 35.3% in the post-pharmacist group (p=0.49). There was also a decrease in 6-month mortality from 16.7% to 14.7% between the pre- and post-pharmacist groups, respectively (p=0.69). Change in MELD score from baseline increased from +2.6 points in the pre-pharmacist group to +5.0 points in the post-pharmacist group (p=0.28).

CONCLUSIONS: HCRU, mortality, and change in MELD score did not decrease significantly post-introduction of a clinic-embedded pharmacist. Additional studies are needed to assess the role of adherence on HE outcomes.