Presenter: Melissa Carroll, PharmD, BCPS, Senior Clinical Pharmacist, McKesson/US Oncology Network
Co-Authors: Shannon Hough, PharmD, BCOP, Director, ClinReview and Clinical Content, McKesson/US Oncology Network; Joshua Howell, PharmD, BCOP, Vice President, Pharmacy and Clinical Programs, McKesson/US Oncology Network; Elizabeth Koselke, PharmD, BCOP, Senior Clinical Pharmacist, McKesson/US Oncology Network; Julianna Kula, PharmD, BCOP, Senior Clinical Pharmacist, McKesson/US Oncology Network
BACKGROUND: The impact and role of a clinical pharmacist in a community oncology setting is not well-described in the literature. The US Oncology Network recently implemented a centralized clinical pharmacist review program (ClinReview) to provide oncology clinical pharmacist services to community oncology practices.
OBJECTIVE: To evaluate the impact of remote clinical reviews by oncology pharmacists in community oncology practices.
METHOD: Oncology-trained clinical pharmacists reviewed electronic files for recently placed or modified chemotherapy regimen orders within 4 community oncology practices. The ClinReview pharmacists identified opportunities to modify ordered therapy, based on clinical variables, waste reduction, or financial stewardship. The recommendations were discussed with the treating oncologist at the community oncology practice or modified the regimen, if permitted by approved practice policy. Each pharmacist was appointed at half full-time equivalents. Financial and workload metrics were tracked to monitor the impact of the pharmacist interventions.
RESULTS: In 28 weeks, 2234 reviews were documented, and 1038 (46.5%) required modification by a pharmacist. The recommended modifications included 440 (42%) clinical change, 433 (42%) dose rounding, and 165 (16%) medication substitution. The most common clinical changes included 146 (33%) recommendations for additional monitoring, 137 (31%) modifications to supportive care, and 106 (24%) modifications to anticancer medication dose or frequency. Of these clinical recommendations, 235 (53%) were identified by the ClinReview pharmacist as directly influencing patient safety. The clinical pharmacist was remotely integrated into the care team, influencing complex patient care decisions, such as anticancer regimen selection and dosing. The financial impact of the pharmacist resulted in margin improvements totaling $522,473, and a reduction of $2,766,001 in the total cost of care in medication expenses. The expense of the pharmacists during this period was $117,571. To date, the return on investment for the pharmacists compared with the margin improvement was 444%.
CONCLUSION: Community oncology practices seek to provide high-value care in a resource-constrained model. An oncology clinical pharmacist is a cost-effective and clinically invaluable member of the care team in community oncology practices. Pharmacists identified opportunities to improve medication safety, drug regimen optimization, and demonstrated substantial financial impact on small-scale budgets in community oncology practices. Oncology-trained pharmacists are chemotherapy experts who are well-equipped to review clinical orders in a complex patient population at risk for medication-related adverse effects.