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Summer 2019 (Volume 29, Number 2)

The CRA Practice Reflection Award:
Dr. Jason Kur, Dr. Kam Shojania, and Dr. Ken Blocka

Implementation of a Standardized Immunosuppressant Risk Review Checklist

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The complexity of rheumatologic patient care has escalated over recent years. The introduction of immunosuppressant and immunomodulatory medicines over the past two decades to treat rheumatic diseases, while immensely helpful for patients suffering from inflammatory conditions, carries potential risks.

Pharmacare data in British Columbia (B.C.) demonstrates that the use of biologic medications continues to rise. Many of the advanced therapeutics used to treat rheumatoid arthritis raise general concerns, for instance, reactivation of tuberculosis and increased risk of infection. In other fields of medicine such as diabetes, anaesthesia, and congestive heart failure clinics, checklists and care reviews have been implemented successfully. This has resulted in evidence-based improvement in patient outcomes. It is also well known that patients with arthritis use healthcare facilities more often (13%) than patients with other chronic diseases (10%) and the general population (5%).

In 2012, rheumatologists in B.C. funded the implementation of an immunosuppressant review tool. This checklist tool, developed by Dr. Kam Shojania, Dr. Ken Blocka, and Dr. Jason Kur (and updated in 2017), explores patient risk factors and potential complications that are encountered when placing patients on prednisone, disease-modifying anti-rheumatic drugs (DMARDs) and biologics. The immunosuppressant checklist tool helps to reduce unwanted exposure to risk and to improve health promotion. It does this through discussion and documentation of activities such as travel and vaccinations.

This tool can be employed on an annual basis in patients with inflammatory diseases (typically rheumatoid arthritis) and it allows rheumatologists to systematically ensure their patients receive the most appropriate counselling.

The immunosuppressant tool has been successfully implemented in all rheumatology clinics throughout the province of B.C. With this widespread uptake in a short period of time, it is our hope this tool will help improve long-term outcomes for our patients and advance the quality of care in rheumatology.

Dr. Jason Kur (middle) receiving the Gold Practice Reflection Award from Dr. Vandana Ahluwalia (left) and Dr. Raheem Kherani (right).

Jason Kur, MD, FRCPC
Clinical Assistant Professor,
University of British Columbia
Medical Director,
Artus Health Centre
President, B.C. Society of Rheumatologists
Vancouver, British Columbia

Kam Shojania, MD, FRCPC
Clinical Professor and Head,
UBC Divison of Rheumatology
Medical Director, Mary Pack Arthritis Program
Vancouver, British Columbia

Ken Blocka, MD, FRCPC
Clinical Professor,
Rheumatology, Faculty of Medicine,
Department of Medicine,
University of British Columbia
Vancouver, British Columbia

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