Incorporating a clinical pharmacist into the National Hemophilia Foundation’s (NHF) comprehensive care model for patients with hemophilia improved patient outcomes and reduced medication costs, according to the results of a study published in The Permanente Journal.

The NHF’s comprehensive care model includes a core team with a hematologist, nurse hemophilia specialist, physical therapies, social worker, and a specialized laboratory. The aim of this study was to determine if the addition of a clinical pharmacist would affect outcomes in an integrated health care system.

The multicenter, retrospective study analyzed data from 110 male patients with hemophilia A or B who were enrolled in the hemophilia pharmacy service between 2017 and 2019. Clinical pharmacists provided services via centralized location using telemedicine. Patients could contact and use the pharmacists as a source of education and help with financial assistance programs. The pharmacists also provided multiple clinical services to the core care team, such as taking bleeding histories, developing comprehensive factor replacement plans, and developing individualized perioperative plans. The primary outcomes were annualized bleed rates (ABRs), emergency department (ED) visits, and hospitalizations.

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The addition of a clinical pharmacist resulted in a trend toward improved patient outcomes, but these were not statistically significant. There was a reduction in the ABR from 40 to 37.6 per 100 patient-years (P =.78), ED visits from 22.7 to 18.3 per 100 patient-years (P =.48), and hospitalizations from 6.4 to 3.0 per 100 patient-years (P =.27)

The access to prophylaxis treatment increased during the study with 50% of patients having an medication possession ratio (MPR) of 0.80 or higher compared with 61% of patients after a clinical pharmacist was added to the team, but this was not significant (P =.32).

Clinical pharmacists implemented a factor recycling program, which enabled more efficient use of factor replacement therapy and personalized vial sizes, which resulted in a savings of $900,000 over 1 year.

The authors concluded that “the addition of a clinical pharmacist with an expertise in hemophilia leads to positive trends toward improved bleeding outcomes for patients, improved medication adherence, and substantial drug cost savings to the health system.”


Lee D, Le AO, Meganck M, et al. Adding a clinical hemophilia pharmacist to the hemophilia comprehensive care model improves health care–related outcomes and drug-related costs in an integrated health care system. Perm J. 2022;26(3):1-4. doi: 10.7812/TPP/21.192