Presenting Authors: Katie Jo Cash, PharmD, CSP, and Kristin Hutchinson, PharmD, BCOP, CSP, CPS Solutions, LLC, Dublin, OH
Co-Authors: Kayla Ann Phillips, PharmD, Mercer University, Macon, GA; Carly Giavatto, PharmD, Ana Lopez Medina, PharmD, Casey Fitzpatrick, PharmD, Andrew Wash, PharmD, PhD, Jessica Mourani PharmD, Abbey Hunter, PharmD, CSP, and Brandon Hardin, PharmD, MBA, CSP, CPS Solutions, LLC, Dublin, OH
BACKGROUND: Several studies have illustrated value in early patient contact following oral anticancer medication (OAM) initiation, particularly within the first 14 days of therapy, as adverse effects may inspire early discontinuation and poor adherence. Health system specialty pharmacies (HSSPs) are optimally positioned for pharmacists to adopt this best practice for early contact and formalize protocols to identify and mitigate issues. Despite clear advantages of early OAM patient contact, evaluating pharmacist-generated interventions resulting from this check-in is needed to understand the impact of early patient-pharmacist contact following the initiation of OAM.
OBJECTIVE: To describe the interventions created following a HSSP pharmacist-led 14-day check-in protocol in patients receiving OAM.
METHODS: CPS client HSSPs enacted a protocol in January 2022 requiring embedded oncology clinic pharmacists to contact patients within 14 days of OAM initiation, aiming to optimize adverse-effect management, offer needed supportive care, address adherence, and provide education. This retrospective, multicenter, descriptive study reviewed intervention data linked to this protocol across CPS client health systems from January 2022 to November 2023. The interventions included were for patients with cancer aged ≥18 years who were prescribed OAM and were clinically managed by HSSP pharmacists. Interventions were excluded if they were canceled or if there were incomplete or missing details. The intervention types included adherence, adverse drug reaction (ADR), laboratory, drug information/education, vaccine, and regimen appropriateness. Intervention types were further categorized for reason, recommendation, and acceptance. Data analysis evaluated the intervention count, type, category, and acceptance rate.
RESULTS: In total, HSSP pharmacists created 1698 interventions from the 14-day check-in call. The average patient age was 66.3 ± 13.5 years (range, 22-95 years). The most frequently cited cancer diagnoses were breast (25.4%), gastrointestinal (14.4%), and prostate (12.1%). The medications that most frequently required interventions were capecitabine (12.9%) and abemaciclib (8.5%). The most frequent intervention types were ADR (91.2%), followed by adherence (3.2%) and regimen appropriateness (2.9%). HSSP pharmacist recommendations included counseling on mitigation strategies (53.6%), recommending a new therapy (20.1%), recommending an office visit (10.2%), recommending a therapy change (8.9%), and providing disease/drug education (4.7%). Overall, 95.5% of pharmacist recommendations were accepted, 2.6% required a follow-up, and 1.8% were declined.
CONCLUSION: Implementing a 14-day check-in protocol allows HSSP pharmacists to mitigate barriers to OAM adherence and promote persistence. This study validates the importance of early check-in and illustrates the scope of the oncology pharmacist’s role by evaluating critically meaningful interventions and quantifying pharmacist recommendations and acceptance.
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