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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