Implementation of a telephone callback service for ambulatory oncology patients

Introduction. A pilot project was established at the Cross Cancer Institute pharmacy to assess the feasibility of implementing a patient callback program to determine which patients would benefit from a callback and the impact a callback service would have on the workload of the pharmacy department.

Program description/development/implementation/evaluation. A pharmacy student conducted the pilot project over a 14-week time period. Four categories of patients were selected for inclusion in the pilot. The student approached patients at the time of medication pick-up to receive verbal permission to be included in the callback program. A standardized callback form was utilized to record medication information and any recommendations made. Data were collected on the numbers of patients in each category with questions or concerns as this was felt to be indicative of patients who would most benefit from a callback. The total time spent making the telephone calls was recorded. Over the eight-week period, 530.5 minutes were spent making the telephone calls with the average length of call being 3.27 minutes.

Discussion/conclusion. The student researcher proposed that three patient groups would benefit from receiving a callback: new patients or patients on new medications; elderly patients; and patients with specific disease-drug combinations. The project also provided an estimate of pharmacist time required to implement such a service and it was concluded that implementation could occur with minimal disruption to workflow.

Benchmarking pharmaceutical care within the Alberta Cancer Board

Objective. To describe the numerous pharmacy ac tivities afforded by the seven pharmacy sites that provide various levels of pharmacy services to cancer patients in cities throughout Alberta, Canada.

Methods. A questionnaire for measuring phar maceutical care (PC) was developed and applied to each site to benchmark the level of PC that was offered at each institution. The survey was con structed based on elements of the PC model of Hepler and Strand et al and grouped along the lines of Cal Knowlton's ABCs of PC. Responses were graded according to what degree the site had fully, partially, or not yet incorporated the element surveyed.

Results. Overall, 44% of the PC elements were fully implemented, 33% were partially implemented, and 23% were not yet implemented in the newly formed Alberta Cancer Board Pharmacy Department. The traditional areas of bottling and counseling con tinue to be areas of strength, with 79% and 77% of the elements fully implemented, respectively. More em phasis is warranted in the areas of assessment and surveillance, with only 26% and 29% of the elements fully implemented, respectively.

Conclusions. The results of the survey indicate the need for continued planning to incorporate some of the elements of cognitive pharmacy services in the Alberta Cancer Board Pharmacy Department strategic plan.

Chemotherapy Dosing Part I: Scientific Basis for Current Practice and Use of Body Surface Area

Cytotoxic chemotherapy is characterised by a low therapeutic index and significant variability in therapeutic and toxic effects. In an attempt to reduce this variability, most chemotherapy doses are individualised according to patient body surface area (BSA). This practice, which was introduced almost 50 years ago, clearly has practical and economic implications for the healthcare system. Furthermore, the clinical value of this approach has, in recent years, been questioned. Despite established practice, chemotherapy dose selection remains complicated, partly because treatment effects are difficult to measure, partly because drugs are used in combination with other treatment modalities, and also because the patient's condition may change with disease progression. Various patient-related factors can affect drug pharmacokinetics (PK) and pharmacodynamics (PD), for example organ function, expression and activity of metabolising enzymes, drug resistance, body size, gender, age, concomitant disease and co-administration of other drugs. These factors may be of clinical significance in chemotherapy dose determination and measures of PK, PD or both feature in attempts to devise more rigorous methods for chemotherapy dosing. Part I of this series of two reviews describes the history and clinical impact of BSA-based chemotherapy, and examines the scientific evidence to support BSA dosing. It evaluates the factors affecting PK and PD for specific drugs that could inform and refine dose determination.