Finding consensus on meaningful reporting measures for rheumatoid arthritis: Results from a modified Delphi study

Though specialty pharmacies collect and report a myriad of measures to internal and external stakeholders, these data are infrequently used for evaluating specialty pharmacy performance or clinical decision-making. Establishing standardized specialty pharmacy measures could enable benchmarking, performance-based contracting, and high-cost drug utilization management while improving patient care and specialty medication management.

To determine consensus among specialty pharmacy stakeholders on important and usable measures for specialty pharmacies managing patients with rheumatoid arthritis (RA).

A modified Delphi study was conducted with a multisite study group (n = 25 sites). Expert panelists from diverse RA-related backgrounds participated in up to 3 survey rounds. An environmental scan informed an initial list of 10 generalized measures. In rounds 1 and 2, panelists rated each measure's importance and usability on an 11-point Likert scale. Measures were categorized to be included, excluded, or rescored based on mean scores. Panelists received group scores and feedback between rounds. In round 3, specialty pharmacy-affiliated panelists assessed the feasibility of measures that reached consensus. Final study group voting categorized measures as core (should be collected and reported by all specialty pharmacies without exception), reach (important and actionable but not yet essential for specialty pharmacies to collect and report), or neither.

Of 315 recruited panelists, 118 participated; response rates were 83% (round 1), 76% (round 2), and 73% (round 3). In round 1, 4 measures met consensus; 3 measures moved forward to be rescored in round 2, and 2 general measures were delineated to more specific measures for feasibility scoring. Feasibility consensus varied. Final study group voting identified 7 specific core measures: adherence, serious adverse effects, patient response to therapy, medication discontinuation, medication switching, and tuberculosis and hepatitis B screening (if applicable). Six reach measures included immunization screening, drug-specific laboratory screening, common AEs, patient functional status, patient disease activity, and medication persistence.

There was a high survey response rate within each round. Consensus was reached for 13 measures deemed important and usable by specialty pharmacy stakeholders, with most considered moderately/very feasible by specialty pharmacists.