INFUSING Clinical Corner - Joint Health Interview with Heidi Purrington - Brothers Healthcare
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INFUSING
BONDED BY BLOOD | BROTHERSHEALTHCARE.COM | WINTER 2021
Clinical Corner
Joint Health Interview
with Heidi Purrington
Page 4
Decoding the
RX Label
Page 6
Gratitude and
Growth
Page 3
Advocacy Update
Excerpts from the HFA’s
Washington Wire
Page 8
A Pharmacy
Specializing
in You.
Complex Home Infusion Therapies
& Patient Management
At the heart of Brothers Pharmacy
is patient-centered, compassionate
care delivered by our infusion
pharmacy team. We are committed
to transitioning patients home with
extraordinary care, fully supported by
our knowledgeable clinical staff, and
commitment to patient safety.
Monday - Friday, 9am - 5pm | 24/7/365 for After-hours or Emergency Services
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FROM THE EDITOR
Change is upon us!
We are excited to announce changes to the Brothers
Healthcare newsletter. Our beautiful redesign is FOUNDERS’
coupled with a new name, Infusing Life, which is FORWARD
fitting for a fresh start to the new year. As we transition to a new
year, growth continues to
Infusing Life brings to mind feature messages from our man- be a theme for Brothers
“
both our focus on infusion ufacturer sponsors, to highlight Healthcare. Last year,
therapies and our commitment products and services relevant we added fantastic new
Learn how to the whole-person approach
to healthcare. With each infusion
to you. team members, educa-
tional programs, payer
Brothers of life-changing therapies, each This issue will help you de- contracts, and even a
phone call, and each warm smile, code your prescription label, new arm of our business:
we honor you and your family. understand more about joint Brothers Pharmacy.
Healthcare A few other changes you’ll find
health, and visualize the clotting
process. You’ll also get an
These elements expand
our scope but also bring
puts patients in Infusing Life, is a Clinical
Corner article for healthcare
advocacy update and learn
how Brothers Healthcare puts
us back to our core mis-
sion: unmatched patient
first…”
professionals in the bleeding patients first. care. We are grateful for
disorders community. These the hard-working team
articles are written by experts Happy Reading!
we have built and the
for experts. We are also proud to —Jessica Steed, Editor patients who trust us
with their care.
Wishing you a
2021 filled with
SCHOLARSHIP gratitude
and growth!
INFORMATION Scott Carthey and
Kevin Shaughnessy
ASK US!
Presidents and
Our committee will select two Co-founders
students with bleeding disor-
Call or email us with any ders, a male and a female, to
questions you have about receive a $1000 scholarship
sports, life, relationships or award. Applications and
your managing your med- details are available on our
ical condition and we will The third annual Brothers website: Brothershealth-
lend our expertise to help Healthcare scholarship care.com/scholarship-ap-
you in any possible way. award program applica- plication.
tions will open January 15,
(800) 291-1089 2021. Please note there are For questions email:
info@brothershealthcare.com changes to criteria this year. info@brothershealthcare.com
3
CLINICAL CORNER
JOINT HEALTH
O V ER
TIME
Clinical Corner is a new feature in Infusing Life and is targeted at health-
care professionals in the bleeding disorders space. Each issue will cover
a specific topic detailed by an expert in the community. It is our hope that
healthcare providers will use this information in their practice to benefit
their bleeding disorders patients. In this, our first article, please enjoy an
interview with physical therapist Heidi Purrington by Jessica Steed dis-
cussing the findings of the Joint Outcome Continuation Study (JOS-C)1
and other aspects of joint health.
Heidi Purrington and with improving overall health treatment throughout childhood,
PT, DPT, PCS, CBIS and participation in desired daily we are still seeing increased
Heidi has been a physical and recreational activities. joint damage and restrictions in
“
therapist at the Hemophilia and activities in people with bleeding
Thrombosis Center at Phoe- disorders. Also, once there is
Education is a
Steed: Thank you for sharing this
nix Children’s Hospital since study and talking about the find- damage to the joint structures,
2004. She received her Doctor ings. It’s my understanding that that joint damage is more likely
key component of Physical Therapy from the
University of Minnesota. She
the original Joint Outcome Study
(JOS)2 was pivotal in making
to progress. Another recent
study3 examined MRI findings of
to prevent
is a board-certified pediatric prophylaxis a standard of care for joint damage and the likelihood
specialist and certified brain severe hemophilia patients in the that a person with severe hemo-
injury specialist. Heidi served as US. This extension study follows philia will have more bleeding
progressive the Mountain States Regional
representative for the National
many of the patients to examine
changes to their joints over time.
and progressive damage of that
joint over a 5-year period.
joint damage.” Hemophilia Foundation Physical
Therapy Working group from
As a PT, what was the biggest
takeaway for you?
Another interested part of this
study showed that kids partici-
2010 – 2014. She enjoys working pating in sports and activities did
with children and adults in the Purrington: The main takeaway not have significantly increased
treatment center to assist with for me is that even with current incidence of joint injury. This has
recovery from injury or surgery treatment recommendations and been seen in other studies as well.
4
S: Were there any surprises
for you in this study?
P: No, I don’t think so. It was
nice to see that the participants
generally rated their overall
“
quality of life as good. That’s
important.
Also, it is interesting to see Many centers
are using
that the PT exam scores cor-
related well with the MRI scores
at least for later stages. This has
not been shown to be true for
early joint damage. We know
musculoskeletal
that MRIs are a more precise
way to examine joint structures, ultrasound in
but they are not practical to
monitor joint health and we must
rely on physical exam findings to
addition to PT
help us identify early problems in
the clinic.
exams to better
Many centers are using mus-
culoskeletal ultrasound (MSKUS) monitor joint and
in addition to PT exams to better
monitor joint and muscle health
and recovery from bleeds. It can
muscle health
help us determine how to proceed
after a bleed to help prevent and recovery
from bleeds.”
damage later. It has also been
used as a good educational tool.
S: What elements of the study
are the key takeaways for
busy clinicians?
P: It shows we are likely to still
see joint damage over time, so
we must consider what else
study inform your recommen- disorders who have joint and long-term joint damage than
are we going to do to prevent
dations for physical therapy damage? the general population.
damage and especially progres-
for your patients?
sion of joint damage to the point P: What I see from this study S: Heidi, this has been very
where there is chronic pain, loss P: I think it is important that and my experience, is that while insightful. Thank you for your
of motion and difficulty with ac- physical therapy is part of the we continue to see incidents time.
tivities. As PTs, we recommend multidisciplinary care provid- of joint damage in children
safe participation in sports, ed to reduce potential joint and adolescents with bleeding P: You’re welcome. Thank you
PRICE (or POLICE) for bleeds, damage. Physical therapy may disorders, there are still much for the opportunity to discuss an
full recovery of joint and muscles involve a phone call, a single fewer people than in previous area I am passionate about.
and progressive return to sports/ clinic visit or ongoing physical generations who will have long
References:
activity. It seems education is therapy services. If a child or term consequences of severe 1. Warren, B. B., Thornhill, D., Stein,
a key component to prevent teen is developing a problem joint damage as a result of their J., Fadell, M., Ingram, J. D., Funk,
progressive joint damage and joint, we’ll need to determine bleeding disorder. Compared to S., Norton, K. L., Lane, H. D.,
Bennett, C. M., Dunn, A., Recht,
there are many great handouts if they need bracing or orthot- previous generations our kids M., Shapiro, A., & Manco-Johnson,
and videos available. However, ics. Do they need to improve and young adults are able to M. J. (2020). Young adult outcomes
education and resources do of childhood prophylaxis for severe
strength, flexibility, balance, and/ participate in a wider range of hemophilia A: results of the Joint
not always help the patient. As or coordination? Do we need to activities and many have never Outcome Continuation Study.
clinicians, we need to figure out re-evaluate what activities they had a bleed. Of course, this is Blood Adv (2020) 4 (11): 2451-
2459. https://doi.org/10.1182/bloo-
what is important for each pa- are participating in and how not at 100% with no bleeds yet dadvances.2019001311
tient and support them as they we can help them participate which is what we want. With all 2. Manco-Johnson MJ, Abshire TC,
make choices in their health. without causing more damage or of the new therapies becoming Shapiro AD, et al. Prophylaxis ver-
sus episodic treatment to prevent
We may also see improved bleeding? The recent use of tele- more available and ongoing sup- joint disease in boys with severe
long-term joint health with health has allowed for improved port for general health, I like to hemophilia. N Engl J Med. 2007;
new treatments and the use of 357(6):535-544.
communication and follow up think of the possibilities that peo- 3. Foppen W, van der Schaaf IC,
MSKUS to provide monitoring after a bleed. ple with bleeding disorders will Beek FJA, Mali W, Fischer K. MRI
and education. have better rates of participation predicts 5-year joint bleeding and
S: Does this study line up with in physical activities/sports and
development of arthropathy on
S: As far as patients starting radiographs in hemophilia. Blood
your experience of working decreased incidence of injury Adv 2020; 4:113–121. doi: 10.1182/
or maintaining PT, does this with patients with bleeding bloodadvances.2019001238
5
To learn more about our Free Trial and Co-Pay Assistance
Programs, call us at 800.554.4440
Contact your Octapharma Representative:
NICHOLAS SELF
Phone | 949.933.3257
E-mail | Nicholas.Self@octapharma.com
©2020 Octapharma USA Inc. All rights reserved.
Date of preparation: 7/2020. NUW-0280-CAD www.NUWIQUSA.com
To learn more about our Free Trial and Co-Pay Assistance
Programs, call us at 800.554.4440
Contact your
Octapharma Representative:
ELIZABETH PULLEY
PHONE:
480.280.1085
EMAIL:
Elizabeth.Pulley@octapharma.com
www.wilateusa.com
©2019. Octapharma USA Inc. All rights reserved.
Date of preparation: 4/2019. WIL-0206-CADCOVER STORY
FACTOR 101
PART 1: DECODING THE
LABEL
By Eslam Omar, RPH, MPH Pharmacist
Many patients who have bleeding dis-
orders use clotting factor concentrate
(factor) to treat or prevent bleeding. Often,
when patients receive a factor prescription
(Rx) delivery from our pharmacy, they notice
the Rx label has many numbers and directions. Sometimes, these
numbers are confusing, for example there is a factor range (Nuwiq
4104-5016 IU) on the box, as well as the actual factor units, and
finally the Rx factor units prescribed. So, what do all these numbers
mean and how can we interpret them? Let’s examine an example
prescription label step-by-step.
READING YOUR
FACTOR RX LABEL
With each factor Rx dose, you will get pharmacy label that explains
the content and directions. If you get your factor Rx from Brothers
Healthcare, the Rx label will look like this.
FACTOR RX LABEL KEY
■ Nuwiq: Factor product found on the manufacturer box comes in these vial sizes: 250U, ■ Dosage Range (4104
brand name. The manufacturer and the factor vials. Lot numbers 500U, 1000U, 2000U, 2500U, U- 5016U) Because factor
is Octapharma. are important because if there is 3000U, and 4000U. manufacturers’ products have
a recall on a product it is identi- slight variations in units per vial,
■ Dispensed Dose 4339U is fied by batch and patients who ■ Administer Nuwiq 4560 U
+/- 10% by slow IV push as factor prescriptions are usually
the exact number of internation- have received this product are written in range +/-5%, +/-10%
needed for bleeding. This is
al units (IU), or units (U) for short, notified by the pharmacy. and sometimes +/-15%. To
the dose and directions from
available in this box of Nuwiq. meet this range with available
■ Exp: 11/30/2020 is the ex- your hematologist. Your dose
In this example, this is also the assays, it is also common for
piration date. Always check that is based on your weight (units
patient’s dose. the pharmacy to combine more
date before you infuse factor. It per kilogram) as calculated by
your doctor per manufacturer than one box of factor to make
■ Qty: 2 means there are 2 is best to rotate factor by expi-
1 dose. For example, for Rx
boxes of Nuwiq in this order. ration date the same way you guidelines. This is why you must
update your weight with each of Nuwiq 4000U +/-10%, the
Always check that the quantity would with your groceries. You
factor order. In this example, the pharmacy can dispense Nuwiq
matches the number of doses would use a milk carton expiring
prescription says to administer 1036U + Nuwiq 3177U =
you received. sooner before opening one with
4560 units +/-10%. 4226U. If your dose requires
a later expiration date.
more than one box of factor,
■ Lot#: M849B13292 is the The pharmacy dispensed
you will receive multiple boxes
lot number the manufacturer ■ Nuwiq 4560 units is the 4339U which is slightly below
assigns to each batch they dose, which will be dispensed in the prescribed units, but within in one bag with one label as
produce. The lot number is also one or more boxes (vials). Nuwiq the range of +/-10%. See “Decoding” on page 8
7ADVOCACY UPDATE
“Decoding” continued from page 6
shown in the example below.
FROM THE HFA’S
WASHINGTON WIRE
had lost since 2010. However, subsidies and outreach, and ■ Storage: Keep Refriger-
their success in the Presi- greater Medicare/Medicaid ated is the general rule. Store
dential race did not translate flexibilities for drug purchasing. your factor product in the fridge,
down-ballot where Dem- While states will no longer get preferably in its original manu-
ocrats not only failed to federal approval to narrow key facture box and sealed bag.
make any state-level gains protections under the ACA, We will discuss more about
but lost at least 70 seats they can continue to hinder factor storage, reconstitution,
nationwide, including two state implementation or pursue expired factor disposal, and the
chambers (the New Hamp- alternatives like short-term package insert in the next issue.
shire House and Senate). health plans that could weaken
The victories were critical for the law. (Republican gains in Do you have questions for our
Republicans who preserved Montana and New Hampshire pharmacists about your factor,
Republican dominance in prescriptions or other aspects of
their ability to control the redis- may also increase attacks on
state elections creates your care? Call 1-800-291-1089
tricting process in most states existing Medicaid expansions
hurdles for new Biden Ad- and follow the prompt to reach
over the next decade. in those states.) However, state
ministration. Beeman’s Redlands Pharmacy*
Republican dominance at reforms that have substantial
Going into the 2020 election, the state level may dramatically bipartisan support such as during business hours. For af-
Democrats expected a “blue limit the ability of the incom- guardrails protecting consum- ter-hours emergency calls, leave
wave” at the state level that ing Biden Administration to ers from copay accumulator a message and a pharmacist will
would build upon their substan- pursue an agenda that includes adjusters, balance or “surprise” return your call.
tial gains in 2018, when they expanding the ACA through billing, and step therapy should *Please note: Brothers Health-
won back most of the record public or Medicaid “buy in” continue to progress nationwide care is licensed as Beeman’s
number of legislative seats they options, expanded Marketplace in 2021. Redlands Pharmacy.
BONDED BY BLOOD
BROTHERSHEALTHCARE.COM | 11705 SLATE AVE. STE. 200, RIVERSIDE, CA 92505 | 800.291.1089 | INFO@BROTHERSHEALTHCARE.COM
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