Providing Medication Therapy Management Services for Patients Receiving Oral Chemotherapy at a Comprehensive Cancer Center

Transcription

1 1 Providing Medication Therapy Management Services for Patients Receiving Oral Chemotherapy at a Comprehensive Cancer Center Justin P. Huynh, PharmD Sarah E. Cabral, PharmD, BCOP Rhode Island Hospital

2 2 Objectives 1. Identify two barriers to achieving optimal outcomes for patients receiving oral chemotherapy. 2. Describe the impact pharmacists can have on quality and coordination of care for patients receiving oral chemotherapy. 3. Describe the impact technicians can have on quality and coordination of care for patients receiving oral chemotherapy.

3 3 Comprehensive Cancer Center Provides clinical oncology services at: Rhode Island Hospital East Greenwich The Miriam Hospital Newport Hospital Offers clinical trials through: The Warren Alpert Medical School of Brown University National Institutes of Health

4 4 The Dilemma Uncoordinated health services among patients receiving oral chemotherapy can decrease the quality of and access to care Non-adherence and treatment-related toxicities can result in premature discontinuation and progression of disease Some oral chemotherapy access is impeded by specialty designation by insurers McCue DA, Lohr LK, Pick AM. Pharmacotherapy. 2014;34:

5 5 Our Goal Enable accountable and coordinated care of patients receiving oral chemotherapy at our institution Integration of oncology-trained pharmacists in the ambulatory clinic to provide oral chemotherapyfocused medication therapy management services Enhance patient satisfaction and engagement

6 6 The Process Before Rx Prescriber writes an Rx and sends it to a specialty pharmacy Teach Oncology nurse conducts a formal teach Follow Up Patient follows up with prescriber at next office visit

7 7 The Process After Prescriber writes a script for oral chemotherapy and forwards script to the patient navigator, teach nurse, or social worker Prescriptions are triaged to our specialty pharmacy or forwarded to an insurer-mandated alternative specialty pharmacy Pharmacy, nursing, and social work collaborate to obtain prior authorization and financial assistance

8 8 The Process After Clinic-based oncology pharmacists dispense oral chemotherapy to patient and provide counseling and medication therapy management services at a dedicated teach appointment Pharmacist and nurse perform follow-up assessments to monitor adherence & identify any treatment-related toxicities before scheduled office visit with their prescriber

9 9 to National Quality Standards Quality Oncology Practice Initiative (QOPI) The American Society of Clinical Oncology s (ASCO) quality improvement initiative Prior to Therapy Documented Plan Medication & Dose Administration Schedule Lab & Toxicity Monitoring Frequency of Office Visits Medication Provided to Patient Prior to Initiation Prior to Therapy Education Indication Dosing & Start Date Safe Handling Food & Drug Interactions Adverse Effects Contact Information Follow Up Monitoring Dosing and Start Date Confirmation Symptoms & Toxicities Assessed Symptoms & Toxicities Addressed Medication Assessed Medication Addressed "Quality Oncology Practice Initiative (QOPI )." American Society of Clinical Oncology, 21 Sept <

10 10 to National Quality Standards Initial Spring 2015 to QOPI Standard Audit Indication Dosing & Start Date Prior to Therapy Education Safe Handling Food & Drug Interactions Adverse Effects Contact Information 69% 66% 48% 50% 54% 64% 59% Follow Up Summer 2015 to QOPI Standard Audit Indication Dosing & Start Date Prior to Therapy Education Safe Handling Food & Drug Interactions Adverse Effects Contact Information TBD TBD TBD TBD TBD TBD TBD

11 11 to National Quality Standards Dosing and Start Date Confirmation Initial Spring 2015 to QOPI Standard Audit Symptoms & Toxicities Assessed Follow Up Monitoring Symptoms & Toxicities Addressed Medication Assessed Medication Addressed 42% 76% 58% 37% 25% Follow Up Summer 2015 to QOPI Standard Audit Dosing and Start Date Confirmation Symptoms & Toxicities Assessed Follow Up Monitoring Symptoms & Toxicities Addressed Medication Assessed Medication Addressed TBD TBD TBD TBD TBD

12 12 Pharmacist Interventions Documented Clinical Pharmacy Interventions on Oral Chemotherapy Over a 10-Month Period Type Severity of Potential Outcome Number Side Effect Management High 4 Moderate 3 Disease Symptom Management Moderate 3 Medication Therapy Management Moderate 1 Drug-Drug Interaction High 2 Moderate 2 Subtherapeutic Dose High 2 Missing Frequency High 1 Unclear Directions High 1 Moderate 2 Wrong Dosage Form High 1 Lab Monitoring Moderate 3

13 13 Discussion Lessons Learned Collaboration amongst the healthcare team Open-minded to practice changes Initial Barriers Inconsistency in practice patterns among sites Lack of standardized documentation What Worked Well Utilization of a single electronic medical record Healthcare team physically located on campus On-site specialty pharmacy

14 14 Conclusions The integration of pharmacy services into the routine management of patients receiving oral chemotherapy can overcome barriers to optimal care. With direct access to the prescribers in the clinic, pharmacists can improve adherence and assess toxicities through medication therapy management services. Technicians can improve adherence by making sure financial or access issues are not barriers to care.