1
|
Zanetti MOB, Rodrigues JPV, Varallo FR, Cunha RLG, Simões BP, Pereira LRL. Impact of the insertion of the clinical pharmacist in the Allogeneic Hematopoietic Stem Cells Transplantation team. J Oncol Pharm Pract 2023; 29:375-385. [PMID: 35037789 DOI: 10.1177/10781552211073797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Allogeneic Hematopoietic Stem Cells Transplantation (allo-HSCT) is capable of curing patients with neoplastic or non-neoplastic hematologic disorders or of prolonging their survival. This study assessed if the insertion of the clinical pharmacist in the allo-HSCT team modified the outcomes: transplantation-related mortality, grafting failure, incidence of Graft versus Host Disease, hospitalization time, time for grafting, number of readmissions, number of drug-related problems (DRPs), adherence and knowledge about pharmacotherapy. METHODS Interventional study with historical control carried out in an allo-HSCT unit, in which the intervention group (IG) included 33 individuals who received pharmacotherapy follow-up. Control Group (CG) consisted of 28 individuals. RESULTS A total of 250 DRPs were identified, 59 team's doubts were clarified, and 309 interventions were conducted in the IG. The DRPs mainly arose from safety (51.60%) and effectiveness (38.40%) problems. A mean of 9.36 (SD = 6.97) interventions per patient was obtained, mainly including dose reductions (19.09%), adjustments in administration time (18.12%), educational activities (15.21%) and drug removal (10.68%). Clinical significance of the interventions was considered high (75.7% extremely significant, very significant or significant), as well as their acceptability (89.7% accepted). Each patient attended a mean of 4.68 pharmaceutical consultations (SD = 1.91) after hospital discharge, presenting increase in knowledge (p = 0.0001) and in adherence (p = 0.0115). There was no evidence of differences between the groups in the other outcomes analyzed. CONCLUSIONS The pharmacotherapy follow-up allowed detecting several DRPs and performing interventions of high clinical relevance and acceptability, in addition to improving adherence and individualizing the pharmacotherapy.
Collapse
Affiliation(s)
| | - João Paulo Vilela Rodrigues
- School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Fabiana Rossi Varallo
- School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | | | - Belinda Pinto Simões
- Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | | |
Collapse
|
2
|
Andrick B, Tusing L, Jones LK, Hu Y, Sneidman R, Gregor C, Basu S, Lynch JP, Vadakara J. The impact of a hematopoietic cellular therapy pharmacist on clinical and humanistic outcomes: A RE-AIM framework analysis. Transplant Cell Ther 2022; 28:334.e1-334.e9. [PMID: 35189400 DOI: 10.1016/j.jtct.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/31/2022] [Accepted: 02/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The hematopoietic cellular therapy (HCT) pharmacist is an essential member of the multidisciplinary care team. Yet, standardized incorporation of a pharmacist at transplant centers remains challenging. Implementation science uses theory-driven and systematic approaches to integrate interventions into clinical practice. We describe our experience implementing an HCT pharmacist at our center and conducted a program evaluation using the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. OBJECTIVE To evaluate the impact of HCT pharmacist medication management services on allogeneic stem cell transplant patients utilizing the RE-AIM framework. STUDY DESIGN We implemented one full-time equivalent pharmacist to provide medication management services through a collaborative practice agreement (CPA) to the allogeneic transplant population at a medium-sized center in rural Pennsylvania over a two-year period. The HCT pharmacist documented all in-person and telephonic care encounters in the electronic medical record. A pharmacist intervention tool was developed to document identified medication related problems (MRPs) with corresponding interventions and magnitude of intervention. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework was utilized to evaluate the impact of the HCT pharmacist. Summary statistics including frequency and percentages were presented for categorical variables in RE-AIM domain. RESULTS Over the 2-year period, the HCT pharmacist followed 40 allogeneic patients at our institution accounting for 1531 patient encounters. The average duration of follow-up was 299 days. The HCT pharmacist medication therapy services were able to reach all allogeneic transplants at our institute. The HCT pharmacist managed 388 medications and identified 2156 medication related problems for which the pharmacist provided 2959 interventions. Time in therapeutic range of immunosuppression was 74% when managed by the HCT pharmacist through a CPA. Of the 24 patients and 9 caregivers who completed the patient satisfaction survey, 25 (76%) were strongly satisfied with their care. Pharmacy services were gradually adopted and expanded to incorporate additional populations, including 121 autologous transplant and 272 hematology patient encounters. The role of the HCT pharmacist was justified with hospital administration and sustained as a designated pharmacist role at our center. CONCLUSION The implementation of an HCT pharmacist service can positively impact patient care. The RE-AIM framework provides a methodological approach for programmatic evaluation and generalizability.
Collapse
Affiliation(s)
- Benjamin Andrick
- Enterprise Pharmacy, Geisinger, Danville, PA; Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA.
| | - Lorraine Tusing
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA
| | - Laney K Jones
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA; Genomic Medicine Institute, Geisinger, Danville, PA
| | - Yirui Hu
- Center for Population Health Research, Geisinger, Danville, PA
| | | | - Christina Gregor
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA
| | - Soumit Basu
- The Christ Hospital Cancer Center, Cincinnati, OH
| | | | | |
Collapse
|
3
|
Hossain S, Naber M, Yacobucci MJ. A retrospective observational study of a low fixed-dose rasburicase protocol for the treatment of tumor lysis syndrome in adults. J Oncol Pharm Pract 2021; 28:1326-1331. [PMID: 34115548 DOI: 10.1177/10781552211021147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Tumor lysis syndrome is an oncologic emergency characterized by hyperuricemia. Previous studies have demonstrated that a fixed-dose strategy of rasburicase is as effective as the FDA approved weight-based dose. Albany Medical Center employs rasburicase 1.5 mg in patients with a uric acid (UA) between 8 and 12 mg/dL and 3 mg for UA above12 mg/dL.We aimed to evaluate the UA lowering effectiveness and provider adherence to the institutional protocol, as well as the cost-efficiency of this dosing strategy. METHODS This is a single center, retrospective, cohort study. The electronic medical record was used to identify patients receiving rasburicase and to collect baseline demographic and laboratory data. The fixed-dose strategies of rasburicase 1.5 mg and 3 mg were compared in their degree of UA reduction and clinical outcomes. Cost-savings of fixed-dosing was compared to the FDA-approved weight-based dose. RESULTS Mean UA reduction in the 1.5 mg group (n = 49) from baseline to 24 hours was 2.88 ± 0.88 mg/dL (p < 0.0001) and 4.83 ± 1.39 mg/dL (p < 0.0001) in the 3 mg group (n = 105). A subgroup analysis of patients who received per protocol initial doses of rasburicase showed a mean reduction in UA from baseline to 24 hours of 2.83 ± 0.62 mg/dL in the 1.5 mg group (n = 42) and 6.12 ± 1.87 mg/dL in the 3 mg group (n = 42). Using a low fixed-dose approach resulted in a cost-savings of $138,077.30 annually. CONCLUSION Low fixed-dose rasburicase was an effective treatment, with a dose of 1.5 mg being sufficient to reach a goal UA of less than 8 mg/dL for serum UA levels below 12 mg/dL, while a 3 mg dose is appropriate for levels above 12 mg/dL. Cost analysis indicates this strategy is more cost-efficient than the FDA-approved weight-based dose.
Collapse
Affiliation(s)
- Shahrier Hossain
- Department of Pharmacy, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Martha Naber
- Department of Pharmacy, Albany Medical Center Hospital, Albany, NY, USA
| | - Matthew J Yacobucci
- Department of Pharmacy, Albany Medical Center Hospital, Albany, NY, USA.,Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, NY, USA
| |
Collapse
|
4
|
Saito Y, Uchiyama K, Sakamoto T, Kubota K, Oki H, Iwai M, Takekuma Y, Komatsu Y, Sugawara M. Evaluation of Chemotherapy Regimen Management Practice by Oncology-Specialized and Non-specialized Pharmacists Collaboration. Biol Pharm Bull 2021; 44:293-297. [PMID: 33642541 DOI: 10.1248/bpb.b20-00872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Chemotherapy regimen management is one of the most important oncology pharmacy practices, because chemotherapy is conducted according to the registered regimens. In this study, we evaluated the pharmaceutical practice that assumes the initial confirmation of chemotherapy regimens and the quality of practice sharing between oncology-specialized and non-specialized pharmacists in regimen management committee. Pharmacists initially confirmed the applied regimen prescribed by physicians regarding chemotherapeutic agents and prophylactic supportive care medicines. Following confirmation, the regimens were reviewed by the Hokkaido University Hospital Regimen Management Committee. A total of 233 regimens were reviewed by the committee over three years. In total, 110 pharmaceutical inquiries were conducted, 45% of inquiries were concerning chemotherapeutic agents, of which approximately half were regarding supportive care medicines. Most inquiries were regarding premedication, followed by those on administration time, solvent of infusion medicines, and dosage. Correction was performed for 84.5% of inquiries. There was no significant difference in inquiry rates between practice and trial regimens. We have entrusted the first basic regimen review according to the checklist, creation of the chemotherapy plan document, and registry of the adopted regimens in the ordering system from oncology-certified pharmacists to non-certified pharmacists. Basic regimen review was well conducted by a non-certified pharmacist, and a more advanced review was additionally performed by certified pharmacists. In conclusion, we demonstrated the utility of pharmaceutical confirmation in a chemotherapeutic regimen review, suitable review coverage, and quality practice sharing between oncology-certified and non-certified pharmacists, which is one of the recommended methods in chemotherapy regimen review.
Collapse
Affiliation(s)
| | | | | | - Kosei Kubota
- Department of Pharmacy, Hokkaido University Hospital
| | - Hiromitsu Oki
- Department of Pharmacy, Hokkaido University Hospital
| | - Miwako Iwai
- Department of Pharmacy, Hokkaido University Hospital
| | - Yoh Takekuma
- Department of Pharmacy, Hokkaido University Hospital
| | | | - Mitsuru Sugawara
- Department of Pharmacy, Hokkaido University Hospital.,Laboratory of Pharmacokinetics, Faculty of Pharmaceutical Sciences, Hokkaido University
| |
Collapse
|
5
|
Saito Y, Uchiyama K, Sakamoto T, Yamazaki K, Kubota K, Takekuma Y, Komatsu Y, Sugawara M. Pharmaceutical Care Contributes to the Advanced Management of Patients Receiving Immune Checkpoint Inhibitors. Biol Pharm Bull 2020; 43:1969-1974. [DOI: 10.1248/bpb.b20-00553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
| | | | | | | | - Kosei Kubota
- Department of Pharmacy, Hokkaido University Hospital
| | - Yoh Takekuma
- Department of Pharmacy, Hokkaido University Hospital
| | | | - Mitsuru Sugawara
- Department of Pharmacy, Hokkaido University Hospital
- Laboratory of Pharmacokinetics, Faculty of Pharmaceutical Sciences, Hokkaido University
| |
Collapse
|
6
|
Osemene KP, Ihekoronye MR, Lamikanra A. Knowledge, attitudes, perceptions and practices of community pharmacists about generic medicine in Nigeria. ACTA ACUST UNITED AC 2020. [DOI: 10.1177/1741134320962843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Although generic medicines are used extensively in Nigeria information from community pharmacists about these drugs are scanty and therefore inadequate. This is why this study has been designed to bridge the knowledge gap, attitudes, as well as the perception and practice of community pharmacists about generic medicines in Nigeria. Method A questionnaire-guided cross-sectional survey was used to collect data from 380 community pharmacists who were randomly selected from community pharmacies between April and June 2019 in Southwestern Nigeria. Data generated in the course of this study was analysed with the Statistical Package for Social Sciences version 18. Descriptive statistics were used to summarize data. Chi-square was used to test proportions and to determine associations between categorical variables. Pearson’s Correlation Coefficient was used to determine correlation between dependent variables. Result Mean knowledge score of community pharmacists about generic medicines(GM) was 5.6 ± 2.9 out of a total maximum score of 10. Results showed that 47.9% of respondents had poor knowledge, 27.6% average knowledge and 24.5% good knowledge about GM. Knowledge was significantly associated (p = .000) with all demographic characteristics except professional qualifications. A majority (89%) of the respondents were of the view that patients need more explanations when GMs are dispensed to them. In addition, 90.3% of the respondents were of the opinion that GM will improve access to medicine because they are cheaper and easily affordable. About 93% practice generic substitution without consulting prescribing physicians. Furthermore, 85% of the respondents claim they stock mainly GMs. Conclusion Community pharmacists in Nigeria had a positive attitude, perception and practice about GM, but exhibited sub-optimal knowledge in understanding issues concerning generic medicines. It is concluded that there is the need for continuous training and education to enhance professional knowledge of pharmacists in the area of GM substitution.
Collapse
Affiliation(s)
- Kanayo P Osemene
- Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | | |
Collapse
|
7
|
Population Health Management Approach: Integration of Community-Based Pharmacists into Integrated Care Systems: Reflections from the U.S., Achievements in Scotland and Discussions in Germany. Int J Integr Care 2020; 20:13. [PMID: 32607100 PMCID: PMC7319079 DOI: 10.5334/ijic.5431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The annual amount spent on healthcare per capita is higher and expected to grow in the U.S. compared to healthier level 4 countries (e.g., United Kingdom, Canada, Germany, Australia, Japan, Sweden, Netherlands), while health outcomes continue to be suboptimal [123]. Therefore, healthcare is slowly shifting from a fee-for-service to value-based care, which addresses social determinants of health, promotes outcome-based contracting and employs more Population Health Management (PHM) activities. The root cause for this shift has been the increase in patients' out-of-pocket costs and the pervasiveness of poorer outcomes. PHM has been defined by many as a mindset and activities that support the Triple Aim Initiative (i.e., improving population health, experience of care, reducing costs) [4]. This article outlines the value of pharmacists on health outcomes in the U.S., Germany, and Scotland and innovative PHM approaches through pharmacist collaborative networks, polypharmacy management and pharmacists' integration in care models [15].
Collapse
|
8
|
Spann N, Hamper J, Griffith R, Cleveland K, Flynn T, Jindrich K. Independent pharmacist prescribing of statins for patients with type 2 diabetes: An analysis of enhanced pharmacist prescriptive authority in Idaho. J Am Pharm Assoc (2003) 2020; 60:S108-S114.e1. [PMID: 32127253 DOI: 10.1016/j.japh.2019.12.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/10/2019] [Accepted: 12/18/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES This study describes the development and patients' perceptions of a community pharmacist-led, statin-prescribing service for patients with diabetes and aims to identify why patients indicated for statin therapy were not prescribed therapy at the time of pharmacist consultation. SETTING This pilot service began in 4 community-based Albertsons Companies pharmacies located in western Idaho. Patients eligible for the statin-prescribing service had a current diagnosis of type 2 diabetes, were aged between 40 and 75 years, were currently taking medications to manage their diabetes and had no contraindications to statin therapy. PRACTICE DESCRIPTION Due to recent law changes in Idaho, pharmacists can now prescribe statins and certain other medications without oversight from a medical provider or the need for a collaborative practice agreement. PRACTIVE INNOVATION Patients were identified and contacted by their local community pharmacist to discuss the statin-prescribing service. Once statin therapy was initiated, patients completed a brief, 7-question survey regarding their perceptions of the service. EVALUATION This study evaluated the following: number of patients eligible for the prescribing service, number of patients who received a pharmacist-written statin prescription, and patients' perceptions regarding the service. METHODS Of the 64 patients screened, 18 (28%) were eligible for statin therapy. Of those eligible, 6 (33%) accepted pharmacist services and 4 patients started statin treatment. Two patients were prescribed a statin by the community pharmacist, whereas the other 2 patients contacted their primary care provider and requested a statin prescription at the pharmacist's recommendation. RESULTS Overall, participating patients (n = 4) reported feeling comfortable and satisfied with all aspects of the protocol and their pharmacist's role as a prescriber. CONCLUSION This pilot was the first example of community pharmacists independently prescribing statins outside of the clinic setting. The service could target an important health initiative.
Collapse
|
9
|
Clemmons A. The Hematopoietic Cell Transplant Pharmacist: A Call to Action. PHARMACY 2020; 8:E3. [PMID: 31906486 PMCID: PMC7151652 DOI: 10.3390/pharmacy8010003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 12/20/2019] [Accepted: 12/31/2019] [Indexed: 01/28/2023] Open
Abstract
Recently, the required training and credentials for as well as the various roles of the hematopoietic cell transplant (HCT) pharmacist have been endorsed by the leading organizations in cellular therapy, the American Society of Transplant and Cellular Therapy and the European Society of Blood and Bone Marrow Transplantation. While these documents establish the roles a HCT pharmacist can fulfill within the multi-disciplinary team, few reports have evaluated the impact of the HCT pharmacist on clinical, financial, or quality outcomes. Further, a paucity of information has been reported on types of practice models, such as the use of collaborative practice agreements, or described effective methods to overcome the barriers to the increased utilization of HCT pharmacists. Herein, a brief summary of available information is provided to aid readers in understanding the state of the science for pharmacists practicing in this specialty with the goal to stimulate further research to justify the roles of HCT pharmacists and the correlation of such research to various outcome measures. Practitioners are encouraged to build upon this existing knowledge to create the novel integration and elevation of pharmacy practice to improve outcomes for patients, providers, and payors.
Collapse
Affiliation(s)
- Amber Clemmons
- College of Pharmacy, Department of Clinical and Administrative Pharmacy, University of Georgia, Augusta, GA 30912, USA;
- Department of Pharmacy, Augusta University Medical Center, Augusta, GA 30912, USA
| |
Collapse
|
10
|
Sweiss K, Wirth SM, Sharp L, Park I, Sweiss H, Rondelli D, Patel PR. Collaborative Physician-Pharmacist-Managed Multiple Myeloma Clinic Improves Guideline Adherence and Prevents Treatment Delays. J Oncol Pract 2019; 14:e674-e682. [PMID: 30423263 DOI: 10.1200/jop.18.00085] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE We hypothesized that a multidisciplinary collaborative physician-pharmacist multiple myeloma clinic would improve adherence to treatment and supportive care guidelines as well as reduce delays in receiving oral antimyeloma therapy. METHODS From March 2014 to February 2015, an oncology pharmacist provided consultation for all patients in a specialist myeloma clinic. This included reviewing medications, ensuring physician adherence to supportive care guidelines, managing treatment-related adverse effects, and navigating issues involving access to oral specialty medications (collaborative clinic). RESULTS Outcome measures were retrospectively compared with those of patients being treated by the same physician during the previous year, in which ad hoc pharmacist consultation was available upon request (traditional clinic). The collaborative clinic led to significant improvements in adherence to supportive medications, such as bisphosphonates (96% v 68%; P < .001), calcium and vitamin D (100% v 41%; P < .001), acyclovir (100% v 58%; P < .001), and Pneumocystis jirovecii pneumonia prophylaxis (100% v 50%; P < .001). Appropriate venous thromboembolism prophylaxis in immunomodulatory drug-treated patients was prescribed in 100% versus 83% of cases ( P = .0035). The median time to initiation of bisphosphonate (5.5 v 97.5 days; P < .001) and P jirovecii pneumonia prophylaxis after autologous transplantation was shortened in the collaborative clinic (11 v 40.5 days; P < .001). Furthermore, the number (85% v 21%; P < .001) and duration (7 v 15 days; P = .002) of delays in obtaining immunomodulatory drug therapy were also significantly reduced. CONCLUSION Our collaborative clinic model could potentially be applied to other practice sites to improve the management of patients with multiple myeloma. Prospective studies analyzing clinical outcomes, patient satisfaction, and cost effectiveness of this approach are warranted.
Collapse
Affiliation(s)
| | | | - Lisa Sharp
- University of Illinois at Chicago, Chicago, IL
| | - Irene Park
- University of Illinois at Chicago, Chicago, IL
| | | | | | | |
Collapse
|
11
|
Chung C, Kim S, Bubalo J. Instilling value, quality, and safety through hematology and oncology stewardship. Am J Health Syst Pharm 2019; 76:617-621. [DOI: 10.1093/ajhp/zxz036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Sara Kim
- Mount Sinai Hospital, New York, NY
| | - Joseph Bubalo
- Oregon Health and Science University Hospital and Clinics, Portland, OR
| |
Collapse
|
12
|
Mackler E, Segal EM, Muluneh B, Jeffers K, Carmichael J. 2018 Hematology/Oncology Pharmacist Association Best Practices for the Management of Oral Oncolytic Therapy: Pharmacy Practice Standard. J Oncol Pract 2019; 15:e346-e355. [PMID: 30860937 PMCID: PMC6494244 DOI: 10.1200/jop.18.00581] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE: The aim of the current work was to present a pharmacy practice standard from the Hematology/Oncology Pharmacy Association (HOPA) on the management of oral oncolytic therapy. METHODS: The HOPA Standards Committee organized a work group of oncology pharmacist specialists to create a pharmacy practice standard for the management of oral oncolytic therapy that describes the pharmacist’s role on the cancer care team, provides examples of practice tools and resources, summarizes current data related to outcomes, and discusses opportunities to enhance the care of patients with cancer who receive oral oncolytic therapy. We reviewed primary literature, including currently published oral oncolytic guidelines and HOPA’s Scope of Hematology/Oncology Pharmacy Practice. RESULTS: Management of oral oncolytic therapy was divided into the following primary areas: prescribing, education, dispensing and distribution, and monitoring and follow-up. Pharmacists’ roles were summarized in each area with a focus on interprofessional collaboration, communication, patient safety, and quality of patient care. Standards describe the best practices in each area (Table 1). CONCLUSION: Multiple opportunities exist for pharmacists to enhance the care of patients with cancer who receive oral oncolytics through collaboration with oncology care team members. The role of the oncology pharmacist in the care of this patient population is critical given the complexities related to cost, tolerability, and safety of oral oncolytic medications; issues of access; and the monitoring and follow-up of patients receiving this therapy.
Collapse
Affiliation(s)
- Emily Mackler
- 1 Michigan Oncology Quality Consortium, Ann Arbor, MI
| | - Eve M Segal
- 2 Seattle Cancer Care Alliance/University of Washington Medical Center, Seattle, WA
| | - Benyam Muluneh
- 3 University of North Carolina Hospitals, Chapel Hill, NC
| | - Kate Jeffers
- 4 UCHealth Memorial Hospital, Colorado Springs, CO
| | - Jenna Carmichael
- 5 Geisinger Cancer Institute/Enterprise Pharmacy, Wilkes-Barre, PA
| |
Collapse
|
13
|
Shah GL, Majhail N, Khera N, Giralt S. Value-Based Care in Hematopoietic Cell Transplantation and Cellular Therapy: Challenges and Opportunities. Curr Hematol Malig Rep 2018; 13:125-134. [PMID: 29484578 DOI: 10.1007/s11899-018-0444-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Improved tolerability and outcomes after hematopoietic cell transplantation (HCT), along with the availability of alternative donors, have expanded its use. With this growth, and the development of additional cellular therapies, we also aim to increase effectiveness, efficiency, and the quality of the care provided. Fundamentally, the goal of value-based care is to have better health outcomes with streamlined processes, improved patient experience, and lower costs for both the patients and the health care system. HCT and cellular therapy treatments are multiphase treatments which allow for interventions at each juncture. RECENT FINDINGS We present a summary of the current literature with focus on program structure and overall system capacity, coordination of therapy across providers, standardization across institutions, diversity and disparities in care, patient quality of life, and cost implications. Each of these topics provides challenges and opportunities to improve value-based care for HCT and cellular therapy patients.
Collapse
Affiliation(s)
- Gunjan L Shah
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box 298, New York, NY, 10065, USA.
| | - Navneet Majhail
- Blood and Marrow Transplant Program, Cleveland Clinic, Cleveland, OH, USA
| | - Nandita Khera
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Sergio Giralt
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box 298, New York, NY, 10065, USA
| |
Collapse
|
14
|
Maleki S, Alexander M, Fua T, Liu C, Rischin D, Lingaratnam S. A systematic review of the impact of outpatient clinical pharmacy services on medication-related outcomes in patients receiving anticancer therapies. J Oncol Pharm Pract 2018; 25:130-139. [PMID: 29938594 DOI: 10.1177/1078155218783814] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patients receiving anticancer therapies are frequently prescribed complex and high-risk medication regimens, which at times can result in medication misadventures. The objective of this review was to assess the effect of outpatient clinical pharmacy services on medication-related outcomes in patients receiving anticancer therapies, including patients undergoing radiotherapy. METHODS A systematic review of original publications indexed in EMBASE, MEDLINE and Cochrane Library from June 2007 to June 2017. Eligible studies evaluated outpatient pharmacy clinic services for cancer patients and reported at least one medication-related quantitative outcome measure. Two authors independently reviewed full-text articles for inclusion, then extracted data and performed quality and risk of bias assessments. RESULTS Of 908 identified publications, 13 met predefined eligibility criteria; 1 randomised control trial, 2 controlled cohort studies and 10 uncontrolled before-after studies. Many excluded studies described outpatient pharmacy services but lacked medication-related outcomes. All included studies had informative practice model designs, with interventions for drug-related problems including drug dose optimisation ( n = 8), reduced drug interaction ( n = 6) and adverse drug reaction reporting ( n = 3). Most studies ( n = 11) reported on symptom improvement, commonly nausea ( n = 7) and pain ( n = 5). Of four studies in radiotherapy cohorts, pharmacist involvement was associated with improved symptoms, satisfaction and wellbeing scores. CONCLUSION Few studies have objectively assessed outpatient pharmacy cancer services, even fewer in the radiotherapy settings. Although the results support these services, significant heterogeneity and bias in the study designs prohibit robust conclusions and further controlled trials are required.
Collapse
Affiliation(s)
- Sam Maleki
- 1 Department of Pharmacy, Peter MacCallum Cancer Centre, Victoria, Australia
| | - Marliese Alexander
- 1 Department of Pharmacy, Peter MacCallum Cancer Centre, Victoria, Australia
| | - Tsien Fua
- 2 Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victoria, Australia
| | - Chen Liu
- 2 Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victoria, Australia
| | - Danny Rischin
- 3 Department of Medical Oncology, Peter MacCallum Cancer Centre, Victoria, Australia
| | - Senthil Lingaratnam
- 1 Department of Pharmacy, Peter MacCallum Cancer Centre, Victoria, Australia
| |
Collapse
|
15
|
Barboza-Zanetti MO, Barboza-Zanetti AC, Rodrigues-Abjaude SA, Pinto-Simões B, Leira-Pereira LR. Clinical pharmacists’ contributions to hematopoietic stem cell transplantation: A systematic review. J Oncol Pharm Pract 2018; 25:423-433. [DOI: 10.1177/1078155218782372] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Aims The goal of the present review was to identify studies that assess how pharmaceutical services contribute to hematopoietic stem cell transplantation (HSCT). Methods We conducted a systematic literature review of published studies describing results from clinical services provided by pharmacists working with HSCT, conducted according to PRISMA guidelines ( PROSPERO registration number CRD42017062391). A search strategy was applied within PubMed, CENTRAL, EMBASE, SCOPUS, and LILACS databases in April 2017. Inclusion criteria were observational or experimental studies that addressed the following research question: “What are a clinical pharmacist’s main contributions to HSCT?” The quality of selected studies was evaluated using the Downs and Black checklist. Results We identified 1838 studies, and seven were included in the systematic review. The results indicated that clinical pharmacy is useful during HSCT treatment within both inpatient and outpatient settings. Pharmaceutical contributions identified included management of pharmacotherapy-related problems, participation in discussions with clinical teams, drug reconciliation, patient and team education regarding pharmacotherapy, preparation of guidelines and educational materials, and evaluation of medication adherence. These activities favored the control and prevention of pharmacotherapy-related problems, the maintenance of immunosuppressive serum levels, improvement in patients’ clinical and nutritional status, facilitated medication adherence, and provided economic and humanistic gains. Conclusions Despite the small number of articles discussing the topic under analysis, the results were unanimous in confirming the positive impact of pharmacists’ contributions to clinical practice for HSCT.
Collapse
Affiliation(s)
- Maria Olívia Barboza-Zanetti
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | | | | | - Belinda Pinto-Simões
- Department of Internal Medicine, Ribeirão Preto Medical School, Ribeirão Preto, SP, Brazil
| | - Leonardo Régis Leira-Pereira
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, Ribeirão Preto, SP, Brazil
| |
Collapse
|
16
|
Newland DM, Edwards AR, Hall RC, Maxwell PR. Positive Impact of a Pilot Pharmacist-Run Diabetes Pharmacotherapy Clinic in Solid-Organ Transplant Recipients. Diabetes Spectr 2018; 31:167-176. [PMID: 29773937 PMCID: PMC5951228 DOI: 10.2337/ds17-0029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE Post-transplant diabetes mellitus (PTDM) can lead to significant morbidity and cardiovascular death with a functioning graft. A paucity of literature exists regarding glycemic control in solid-organ transplant (SOT) recipients, including pharmacist management of PTDM. This study aimed to assess the impact of pharmacist interventions on diabetes management in a pharmacist-run PTDM clinic. METHODS This was a single-center, prospective, observational study of 24 adult SOT recipients enrolled in a pilot pharmacist-managed PTDM clinic from 1 January to 30 June 2015. RESULTS Improvements were realized in markers of glycemic control, including changes in A1C, average daily self-monitoring of blood glucose (SMBG) results, fasting SMBG results, and pre-lunch SMBG results from enrollment through at least 3 months of follow-up. Median A1C decreased significantly from 8.05% (interquartile range [IQR] 6.33-11.75) at baseline to 6.45% (IQR 6.05-7.3) at the last follow-up encounter (P = 0.0010). Average daily SMBG results decreased significantly from a median of 191 mg/dL (IQR 138-232 mg/dL) at baseline to 125 mg/dL (IQR 111-167 mg/dL) at the final encounter (P = 0.0023). Median fasting and pre-lunch SMBG results decreased significantly from 153 mg/dL (IQR 117-208 mg/dL) at baseline to 120 mg/dL (IQR 102-134 mg/dL) (P = 0.0064) and from 212 mg/dL (IQR 159-258 mg/dL) to 122 mg/dL (IQR 110-169 mg/dL) (P = 0.0161), respectively. Changes from baseline in other SMBG values, lipid levels, and BMI were not statistically significant. CONCLUSION The results of our study demonstrate that a pharmacist-managed PTDM clinic can significantly affect glycemic control in SOT recipients.
Collapse
Affiliation(s)
- David M. Newland
- Department of Pharmacy, University Health System, San Antonio, TX
| | - Angelina R. Edwards
- Division of Nephrology, Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Reed C. Hall
- Department of Pharmacy, University Health System, San Antonio, TX
| | | |
Collapse
|
17
|
Adherence to Oral Anticancer Medications: Evolving Interprofessional Roles and Pharmacist Workforce Considerations. PHARMACY 2018. [PMID: 29518017 PMCID: PMC5874562 DOI: 10.3390/pharmacy6010023] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Interprofessional care is exhibited in outpatient oncology practices where practitioners from a myriad of specialties (e.g., oncology, nursing, pharmacy, health informatics and others) work collectively with patients to enhance therapeutic outcomes and minimize adverse effects. Historically, most ambulatory-based anticancer medication therapies have been administrated in infusion clinics or physician offices. Oral anticancer medications (OAMs) have become increasingly prevalent and preferred by patients for use in residential or other non-clinic settings. Self-administration of OAMs represents a significant shift in the management of cancer care and role responsibilities for patients and clinicians. While patients have a greater sense of empowerment and convenience when taking OAMs, adherence is a greater challenge than with intravenous therapies. This paper proposes use of a qualitative systems evaluation, based on theoretical frameworks for interdisciplinary team collaboration and systems science, to examine the social interactionism involved with the use of intravenous anticancer treatments and OAMs (as treatment technologies) by describing patient, organizational, and social systems considerations in communication, care, control, and context (i.e., Kaplan’s 4Cs). This conceptualization can help the healthcare system prepare for substantial workforce changes in cancer management, including increased utilization of oncology pharmacists.
Collapse
|
18
|
Collaborative practice agreement in solid organ transplantation. Int J Clin Pharm 2018; 40:474-479. [DOI: 10.1007/s11096-018-0604-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 02/08/2018] [Indexed: 10/18/2022]
|
19
|
Clemmons AB, Alexander M, DeGregory K, Kennedy L. The Hematopoietic Cell Transplant Pharmacist: Roles, Responsibilities, and Recommendations from the ASBMT Pharmacy Special Interest Group. Biol Blood Marrow Transplant 2017; 24:914-922. [PMID: 29292057 DOI: 10.1016/j.bbmt.2017.12.803] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 12/26/2017] [Indexed: 12/14/2022]
Abstract
Pharmacists are increasingly recognized as an essential member of the multidisciplinary team for hematopoietic cell transplant (HCT) patients. However, until recently, their educational background, required training, and potential roles have not been well described. Therefore, the purpose of this manuscript is to provide supporting evidence for the HCT Clinical Pharmacist Role Description, which has been endorsed by several organizations including the American Society for Blood and Marrow Transplantation. This document provides justification for the various roles pharmacists fulfill with respect to medication management, transitions of care, patient and provider education, policy development, quality improvement, and research. Furthermore, evidence supporting the value, financially and otherwise, HCT pharmacists provide is reviewed. Pharmacists in the HCT setting are encouraged to report on novel practice models and potential impact of their services to increase awareness and utilization of HCT pharmacists.
Collapse
Affiliation(s)
- Amber B Clemmons
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, Georgia; Department of Pharmacy, Augusta University (AU) Medical Center, Augusta, Georgia.
| | - Maurice Alexander
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, North Carolina
| | - Kathlene DeGregory
- Department of Pharmacy, University of Virginia Health System, Charlottesville, Virginia
| | - LeAnne Kennedy
- Department of Pharmacy, Wake Forest Baptist Health, Winston Salem, North Carolina
| |
Collapse
|
20
|
Bryk A, Koontz S, Mayor J, Betcher J, Tombleson R, Bookout R, Saunders IM. Characterization of collaborative practice agreements held by hematopoietic stem cell transplant pharmacists. J Oncol Pharm Pract 2017; 25:558-566. [DOI: 10.1177/1078155217745145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Current workforce shortages within the hematopoietic stem cell transplant field necessitate capitalizing on the role of oncology-trained pharmacists. Working within an agreed-upon protocol, pharmacists are able to expand patient care delivery through optimal medication therapy management. Methods An electronic survey was developed by the Advocacy & Policy Working Committee of the American Society for Blood and Marrow Transplantation Pharmacy Special Interest Group and distributed to pharmacists involved in the care of hematopoietic stem cell transplant patients. The primary objective was to assess the current state of collaborative practice agreements in the hematopoietic stem cell transplant setting. Results Forty-eight responses representing 41 institutions were returned. Respondents were mostly female (67%) and practiced in the adult setting (83%). Reponses represented a range of practice experience in hematopoietic stem cell transplant with the majority of the hematopoietic stem cell transplant positions (83%) funded by the department of pharmacy at an academic medical center. Of the 48 responses, 22 (46%) respondents reported having collaborative practice agreements in place; 10 (21%) respondents did not currently have collaborative practice agreements, but were planning to implement them; and 16 (33%) respondents did not have collaborative practice agreements at their institution. Clinical activities performed under a collaborative practice agreement included medication selection and dosing modifications, therapeutic drug monitoring, supportive care management, and management of comorbid conditions and chronic diseases. The most commonly cited barrier to establishing collaborative practice agreements was the inability to secure reimbursement for services provided. No respondents reported a negative impact on job satisfaction. Conclusions The results of this survey provide the pharmacy community with a robust understanding of the current landscape of hematopoietic stem cell transplant pharmacy collaborative practice agreements.
Collapse
Affiliation(s)
- Amy Bryk
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD, USA
| | | | | | | | | | - Ryan Bookout
- H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Ila M Saunders
- Skaggs School of Pharmacy & Pharmaceutical Sciences, UC San Diego, La Jolla, CA, USA
| |
Collapse
|
21
|
Gatwood J, Gatwood K, Gabre E, Alexander M. Impact of clinical pharmacists in outpatient oncology practices: A review. Am J Health Syst Pharm 2017; 74:1549-1557. [DOI: 10.2146/ajhp160475] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Justin Gatwood
- University of Tennessee College of Pharmacy, Nashville, TN
| | | | - Ezra Gabre
- University of Tennessee College of Pharmacy, Nashville, TN
| | | |
Collapse
|
22
|
Chevalier BAM, Watson BM, Barras MA, Cottrell WN. Investigating strategies used by hospital pharmacists to effectively communicate with patients during medication counselling. Health Expect 2017; 20:1121-1132. [PMID: 28370932 PMCID: PMC5600236 DOI: 10.1111/hex.12558] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2017] [Indexed: 11/29/2022] Open
Abstract
Background Medication counselling opportunities are key times for pharmacists and patients to discuss medications and patients’ concerns about their therapy. Communication Accommodation Theory (CAT) describes behavioural, motivational and emotional processes underlying communication exchanges. Five CAT strategies (approximation, interpretability, discourse management, emotional expression and interpersonal control) permit identification of effective communication. Objective To invoke CAT to investigate communication strategies used by hospital pharmacists during patient medication counselling. Design This was a theory‐based, qualitative study using transcribed audiorecordings of patients and hospital pharmacists engaged in medication counselling. Setting and participants Recruited pharmacists practised in inpatient or outpatient settings. Eligible patients within participating pharmacists’ practice sites were prescribed at least three medications to manage chronic disease(s). Main outcome measures The extent to which pharmacists accommodate, or not, to patients’ conversational needs based on accommodative behaviour described within CAT strategies. Results Twelve pharmacists engaged four patients (48 total interactions). Exemplars provided robust examples of pharmacists effectively accommodating or meeting patients’ conversational needs. Non‐accommodation mainly occurred when pharmacists spoke too quickly, used terms not understood by patients and did not include patients in the agenda‐setting phase. Multiple strategy use resulted in communication patterns such as “information‐reassurance‐rationale” sandwiches. Discussion and conclusions Most pharmacists effectively employed all five CAT strategies to engage patients in discussions. Pharmacists’ communication could be improved at the initial agenda‐setting phase by asking open‐ended questions to invite patients’ input and allow patients to identify any medication‐related concerns or issues.
Collapse
Affiliation(s)
| | - Bernadette M Watson
- Department of English, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Michael A Barras
- School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia.,Pharmacy Department, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | | |
Collapse
|
23
|
Chevalier B, Neville HL, Thompson K, Nodwell L, MacNeil M. Health Care Professionals' Opinions and Expectations of Clinical Pharmacy Services on a Surgical Ward. Can J Hosp Pharm 2016; 69:439-448. [PMID: 28123189 DOI: 10.4212/cjhp.v69i6.1606] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Pharmacists have made significant contributions to patient care and have been recognized as integral members of the interprofessional team. Health care professionals differ in their opinions and expectations of clinical pharmacy services. Very little has been published about health care professionals' perspectives on advanced clinical pharmacy roles, such as prescriptive authority or administration of vaccines. In 2013, clinical pharmacy services were introduced in a vascular and general surgery ward where a pharmacist had not previously been assigned. OBJECTIVES To explore surgical nurses' and physicians' opinions and expectations of clinical pharmacy services and to determine how these views changed over time; to compare pharmacists' views of clinical pharmacy services with those of nurses and physicians; and to develop validated survey tools. METHODS Three survey tools were created and validated, one for each profession. Surveys were distributed to nurses and physicians assigned to the general and vascular surgery ward before introduction of clinical pharmacy services and 8 months after implementation. Hospital pharmacists were invited to complete the survey at one time point. RESULTS Differences existed in the opinions of nurses, physicians, and pharmacists about some traditional activities. Nurses and physicians indicated stronger agreement with pharmacists participating in medication reconciliation activities than did pharmacists (p < 0.001), whereas a greater proportion of pharmacists felt that they were the most appropriate health care professionals to provide medication discharge counselling, relative to nurses and physicians (p = 0.001). Respondents supported advanced roles for pharmacists, such as collaborative practice agreements, but there was less support for prescribing, physical assessments, and administration of vaccines. Nurses indicated the strongest agreement with pharmacist prescribing (82% versus 69% among pharmacists and 27% among physicians; p < 0.001). Nurses and physicians expressed strong endorsements of clinical pharmacy services in the surveys' comment sections. CONCLUSIONS The introduction of clinical pharmacy services to a surgical health care team resulted in high levels of satisfaction among nurses and physicians who responded to this survey. Differences in perceptions of traditional clinical pharmacy service activities and advanced practice roles need to be studied in more depth to better understand the factors influencing health care professionals' views.
Collapse
Affiliation(s)
- Bernadette Chevalier
- , BSc(Hon), BScPharm, ACPR, was, at the time of this study, a Drug Utilization Pharmacist with the Nova Scotia Health Authority, Halifax, Nova Scotia. She is now a PhD candidate with the School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, Woolloongabba, Brisbane, Australia
| | - Heather L Neville
- , BScPharm, MSc, is Drug Utilization Pharmacist and Pharmacy Research Coordinator, Nova Scotia Health Authority, Halifax, Nova Scotia
| | - Kara Thompson
- , BSc, MSc, is a Biostatistician with the Research Methods Unit, Nova Scotia Health Authority, Halifax, Nova Scotia
| | - Lisa Nodwell
- , BScPharm, ACPR, is a Clinical Pharmacist with the Nova Scotia Health Authority, Halifax, Nova Scotia
| | - Michael MacNeil
- , PharmD, ACPR, is a Surgery Pharmacist with the Nova Scotia Health Authority, Halifax, Nova Scotia
| |
Collapse
|
24
|
Shank BR, Schwartz RN, Fortner C, Finley RS. Advances in oncology pharmacy practice. Am J Health Syst Pharm 2016; 72:2098-100. [PMID: 26581937 DOI: 10.2146/ajhp150637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Brandon R Shank
- Brandon R. Shank, Pharm.D., BCOP, is Clinical Pharmacy Specialist, Division of Pharmacy, University of Texas MD Anderson Cancer Center, Houston. Rowena N. Schwartz, Pharm. D., BCOP, is Vice President, Clinical Content and Pharmacy Operations, McKesson Specialty Health, The Woodlands, TX. CAPT (Ret.) Clarence Fortner, USPHS, M.S., resides in Rose Valley, PA. Rebecca S. Finley, Pharm.D., M.S., FASHP, is Dean and Professor, Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, PA.
| | - Rowena N Schwartz
- Brandon R. Shank, Pharm.D., BCOP, is Clinical Pharmacy Specialist, Division of Pharmacy, University of Texas MD Anderson Cancer Center, Houston. Rowena N. Schwartz, Pharm. D., BCOP, is Vice President, Clinical Content and Pharmacy Operations, McKesson Specialty Health, The Woodlands, TX. CAPT (Ret.) Clarence Fortner, USPHS, M.S., resides in Rose Valley, PA. Rebecca S. Finley, Pharm.D., M.S., FASHP, is Dean and Professor, Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, PA
| | - Clarence Fortner
- Brandon R. Shank, Pharm.D., BCOP, is Clinical Pharmacy Specialist, Division of Pharmacy, University of Texas MD Anderson Cancer Center, Houston. Rowena N. Schwartz, Pharm. D., BCOP, is Vice President, Clinical Content and Pharmacy Operations, McKesson Specialty Health, The Woodlands, TX. CAPT (Ret.) Clarence Fortner, USPHS, M.S., resides in Rose Valley, PA. Rebecca S. Finley, Pharm.D., M.S., FASHP, is Dean and Professor, Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, PA
| | - Rebecca S Finley
- Brandon R. Shank, Pharm.D., BCOP, is Clinical Pharmacy Specialist, Division of Pharmacy, University of Texas MD Anderson Cancer Center, Houston. Rowena N. Schwartz, Pharm. D., BCOP, is Vice President, Clinical Content and Pharmacy Operations, McKesson Specialty Health, The Woodlands, TX. CAPT (Ret.) Clarence Fortner, USPHS, M.S., resides in Rose Valley, PA. Rebecca S. Finley, Pharm.D., M.S., FASHP, is Dean and Professor, Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, PA
| |
Collapse
|
25
|
Holle LM, Harris CS, Chan A, Fahrenbruch RJ, Labdi BA, Mohs JE, Norris LB, Perkins J, Vela CM. Pharmacists' roles in oncology pharmacy services: Results of a global survey. J Oncol Pharm Pract 2016; 23:185-194. [DOI: 10.1177/1078155216629827] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Oncology pharmacists are capable of providing medication therapy management (MTM) because of their level of training, practice experiences, and responsibilities. Very little data exist about their current practice, including changing roles in the multidisciplinary team, overall impact, and effects in the education of patients and healthcare professionals. Methods A 70-item survey about oncology pharmacists' activities in oral chemotherapy programs, MTM, and collaborative practice agreements (CPAs) was deployed using a web survey tool (Qualtrics, Provo, UT, USA), targeting pharmacist members of American College of Clinical Pharmacy (ACCP) Hematology/Oncology Practice and Research Network (PRN). The objective of this study was to determine oncology pharmacists' activities in areas of oral chemotherapy programs, MTM, and CPAs. A cross-sectional survey was distributed to the ACCP Hematology/Oncology PRN membership. Investigational Review Board approval was obtained. Results Of the 795 members who were sent the survey, 81 members (10%) responded; 33 respondents (47%) are involved with an oral chemotherapy program; with 42% measuring outcomes of programs. Only six pharmacists (19%) have published or presented their data. A total of 28 (35%) respondents provide MTM services, with almost half (43%) of these MTM services being dictated by CPAs. A small fraction of these pharmacists (21.4%) reported conducting quality assurance evaluations of their MTM services and three pharmacists (10.7%) reported publishing their results. Those pharmacists practicing under CPAs ( n = 28) were surveyed as to activities included in their CPA. The most common activities included adjusting medication, ordering, interpreting, and monitoring lab tests, developing therapeutic plans and educating patients. Reimbursement for providing these services was uncommon: MTM (4%), oral chemotherapy program (6%), and CPA services (11%). Reported obstacles to reimbursement included lack of understanding, administrative assistance, or time with setting up reimbursement models within the institution. Conclusion Many oncology pharmacists are participating in oral chemotherapy programs, MTM, and/or CPAs and perceived barriers were identified. Increased efforts should be directed toward prospectively reporting and assessing the impact these services have on patient care.
Collapse
Affiliation(s)
- Lisa M Holle
- Department of Pharmacy Practice, UConn School of Pharmacy, Storrs, CT, USA
| | - Christy S Harris
- Department of Pharmacy Practice, MCPHS University, Boston, MA, USA
| | - Alexandre Chan
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Rebecca J Fahrenbruch
- Fairview Pharmacy Services, University of Minnesota Health Cancer Care, Burnsville, MN, USA
| | - Bonnie A Labdi
- Department of Pharmacy, Memorial Hermann Cancer Center – TMC, Houston, TX, USA
| | - Jocelyn E Mohs
- Oncology/Specialty Pharmacy Services, St. Cloud Veterans Affairs Health Care System, St. Cloud, MN, USA
| | - Leann B Norris
- Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, Columbia, SC, USA
| | - Janelle Perkins
- Department of Pharmacotherapy and Clinical Research, University of South Florida College of Pharmacy, Tampa, FL, USA
| | - Cory M Vela
- Department of Pharmacy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| |
Collapse
|
26
|
Alexander MD, Rao KV, Khan TS, Deal AM, Alexander MD, Rao KV, Khan TS, Deal AM. ReCAP: Pharmacists' Impact in Hematopoietic Stem-Cell Transplantation: Economic and Humanistic Outcomes. J Oncol Pract 2016; 12:147-8, e118-26. [PMID: 26787757 DOI: 10.1200/jop.2015.008797] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This study seeks to evaluate the impact of pharmacists' involvement in the care of patients undergoing bone marrow transplantation (BMT). METHODS This was a three-phase study. In phase 1, inpatient and outpatient pharmacist encounters were totaled and services provided were translated to revenue generated from prescription revenue and billing charges. In phase 2, pharmacists' activities and interventions were associated with time savings estimated by providers. In phase 3, patients and providers were surveyed to assess their expectations, experiences, and value perceptions of pharmacists.A positive response rate of 80%for each survey item was set as the threshold for high expectations and successful service delivery. RESULTS In phase 1, after 6 months of data collection, clinical services were provided to 170 inpatients and 290 outpatients. For inpatients, there was an average discharge prescription revenue of $990 per patient through the outpatient pharmacy. In the outpatient clinic, pharmacist visits generated an additional $23,000 in charges (approximately $80 per patient) and an annual prescription revenue of approximately $840,000 through the outpatient pharmacy. In phase 2, pharmacists' activities led to a total time savings of 122 hours. In phase 3, patients and providers met the predetermined 80% positive response rate for most survey items. The item for which patient and provider responses consistently did not meet this threshold related to pharmacists educating patients about their BMT. CONCLUSION Pharmacists are valuable resources in the care of patients undergoing BMT, as their care translates to increased revenue, provider time savings, and positive perceptions from patients and providers.
Collapse
Affiliation(s)
- Maurice D Alexander
- University of North Carolina Medical Center; and UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Kamakshi V Rao
- University of North Carolina Medical Center; and UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Tippu S Khan
- University of North Carolina Medical Center; and UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Allison M Deal
- University of North Carolina Medical Center; and UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Maurice D Alexander
- University of North Carolina Medical Center; and UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Kamakshi V Rao
- University of North Carolina Medical Center; and UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Tippu S Khan
- University of North Carolina Medical Center; and UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Allison M Deal
- University of North Carolina Medical Center; and UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| |
Collapse
|
27
|
Bauters T, Vinent-Genestar J, Delaney J, Mycroft J, Vandenbroucke J. Role of the clinical pharmacist in a paediatric haemato-oncology stem cell transplantation ward. Eur J Hosp Pharm 2014. [DOI: 10.1136/ejhpharm-2013-000397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
|
28
|
Holle LM, Boehnke Michaud L. Oncology Pharmacists in Health Care Delivery: Vital Members of the Cancer Care Team. J Oncol Pract 2014; 10:e142-5. [DOI: 10.1200/jop.2013.001257] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The goal of this summary is to outline the unique knowledge, skills, and functions provided by oncology pharmacists to facilitate the provision of high-quality, team-based care of patients with cancer.
Collapse
Affiliation(s)
- Lisa Marie Holle
- University of Connecticut School of Pharmacy, Storrs, CT; and The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Laura Boehnke Michaud
- University of Connecticut School of Pharmacy, Storrs, CT; and The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
29
|
Komanduri KV. Pharmacists and physicians in hematopoietic stem cell transplantation: advances and opportunities to use collaborative practice agreements to improve care. Biol Blood Marrow Transplant 2013; 19:505-6. [PMID: 23416093 DOI: 10.1016/j.bbmt.2013.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Accepted: 02/11/2013] [Indexed: 10/27/2022]
Affiliation(s)
- Krishna V Komanduri
- Adult Stem Cell Transplant Program, University of Miami Sylvester Cancer Center, Miami, Florida.
| |
Collapse
|