Advertisement

International Journal of Clinical Pharmacy

, Volume 38, Issue 2, pp 280–288 | Cite as

Pharmaceutical care program for onco-hematologic outpatients: safety, efficiency and patient satisfaction

  • Almudena Ribed
  • Rosa María Romero-Jiménez
  • Vicente Escudero-VilaplanaEmail author
  • Irene Iglesias-Peinado
  • Ana Herranz-Alonso
  • Carlos Codina
  • Maria Sanjurjo-Sáez
Research Article

Abstract

Background Self-administration of oral chemotherapy regimens in the home setting leading to new challenges in the health system. Objective To develop and evaluate a comprehensive pharmaceutical care program for cancer outpatients treated with oral antineoplastic agents. Setting A Spanish tertiary hospital. Methods During 2012, a comprehensive pharmaceutical care program was elaborated following the standards recommended by ASCO. It comprised a standard procedure focusing on: drug indication, dosing regimen, required laboratory tests, route of administration, interactions with other current medications and adverse events; a checklist and informational brochures. A pharmaceutical follow up was defined and structured into three clinical interviews over 6 months which focused on safety and efficiency outcomes. Patients starting treatment with oral antineoplastic agents during 2011 (control group) without pharmacist monitoring were compared to patients beginning treatment at some point in 2013 who were prospectively monitored by a pharmacist (intervention group). Statistical analysis was performed by the statistical program SPSS, 21.0 and p < 0.05 was considered significant. Main outcome measures Patient demographics and clinical data were recorded. The primary endpoint was safety outcomes: detection of drug related problems, drug interactions, and adverse events. Adherence, permanence and patient satisfaction were also collected. Results A total of 249 patients were enrolled in the study. Two hundred and seventy-five medication errors were recorded [106 in the control group and 169 in the intervention group (p = 0.008)]. The pharmacist intervened in 362 occasions being accepted 88.8 % of the time, mainly to reinforce patient education and literacy and giving information on co-administration with other drugs and herbal medicines. Adherent patients increased at the 6th month of treatment in the intervention group by 20 % (p < 0.001). High satisfaction was reported. Conclusion The program has been implemented and evaluated successfully. It ensures a high quality and standard of pharmaceutical care with high patient satisfaction rate and the key points to prioritize for improvement in terms of safety (interactions and administration errors) and efficiency (adherence and permanence) of oral antineoplastic agents.

Keywords

Oncology Oral antineoplastic agents Outpatient Patient satisfaction Pharmaceutical care Safety Spain 

Notes

Funding

The authors have no financial support or financial conflicts.

Conflicts of interest

The authors have no personal connections that could be perceived to bias their work. There is no conflict of interest that should disclose.

References

  1. 1.
    Partridge AH, Avorn J, Wang PS, Winer EP. Adherence to therapy with oral antineoplastic agents. J Natl Cancer Inst. 2002;94:652–61.CrossRefPubMedGoogle Scholar
  2. 2.
    Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. GLOBOCAN 2012 v1.0, cancer incidence and mortality worldwide: IARC cancerbase no. 11 [Internet]. Lyon. France: International Agency for Research on Cancer; 2013. http://globocan.iarc.fr.
  3. 3.
    Neuss MN, Polovich M, McNiff K, Esper P, Gilmore TR, LeFebvre KB, et al. 2013 updated American Society of Clinical Oncology/Oncology Nursing Society chemotherapy administration safety standards including standards for the safe administration and management of oral chemotherapy. J Oncol Pract. 2013;9(2 Suppl.):S5–13.CrossRefGoogle Scholar
  4. 4.
    Aisner J. Overview of the changing paradigm in cancer treatment: oral chemotherapy. Am J Health Syst Pharm. 2007;64:4–7.CrossRefGoogle Scholar
  5. 5.
    Institute for Safe Medications Practices. ISMP’s list of high-alert medications. Huntingdon Valley: ISMP; 2014. http://www.ismp.org/tools/highalertmedications.pdf (Accessed 27 Jan 2015).
  6. 6.
    Goodin S, Griffith N, Chen B, Chuk K, Daouphars M, Doreau C, et al. Safe handling of oral chemotherapeutic agents in clinical practice: recommendations from an international pharmacy panel. J Oncol Pract. 2011;7:7–12.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Walsh KE, Dodd KS, Seetharaman K, Roblin DW, Herrinton LJ, Von Worley A, et al. Medication errors among adults and children with cancer in the outpatient setting. J Clin Oncol. 2009;27:891–6.CrossRefPubMedGoogle Scholar
  8. 8.
    Kruse V, Somers A, Van Bortel L, De Both A, Van Belle S, Rottey S. Sunitinib for metastatic renal cell cancer patients: observational study highlighting the risk of important drug–drug interactions. J Clin Pharm Ther. 2014;39:259–65.CrossRefPubMedGoogle Scholar
  9. 9.
    Narasimhan NI, Dorer DJ, Niland K, Haluska F, Sonnichsen D. Effects of food on the pharmacokinetics of ponatinib in healthy subjects. J Clin Pharm Ther. 2013;38:440–4.CrossRefPubMedGoogle Scholar
  10. 10.
    Weingart SN, Flug J, Brouillard D, Harway L, Partridge A, Bartel S, et al. Oral chemotherapy safety practices at US cancer centres: questionnaire survey. BMJ. 2007;334:407–9.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Abramowitz PW, Shane R, Daigle LA, Noonan KA, Letendre DE. Pharmacist interdependent prescribing: a new model for optimizing patient outcomes. Am J Health Syst Pharm. 2012;69:1976–81.CrossRefPubMedGoogle Scholar
  12. 12.
    Lexi-comp ONLINE [Internet]. Hudson: Lexi-Comp; 1978. http://online.lexi.com/crlsql/servlet/crlonline (Accessed 28 Nov 2014).
  13. 13.
    Van Mil F. Drug-related problems: a cornerstone for pharmaceutical care. J Malta College Pharm Pract. 2005;10:5–8.Google Scholar
  14. 14.
    National Cancer Institute. Common terminology criteria for adverse events (CTCAE), version 4.03. Bethesda. US Department of Health and Human Services, National. Institutes of Health; 2010. (Accessed 4 Nov 2014).Google Scholar
  15. 15.
    Marin D, Bazeos A, Mahon FX, Eliasson L, Milojkovic D, Bua M, et al. Adherence is the critical factor for achieving molecular responses in patients with chronic myeloid leukemia who achieve complete cytogenetic responses on imatinib. J Clin Oncol. 2010;28:2381–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Wong SF, Bounthavong M, Nguyen C, Bechtoldt K, Hernandez E. Implementation and preliminary outcomes of a comprehensive oral chemotherapy management clinic. Am J Health Syst Pharm. 2014;71:960–5.CrossRefPubMedGoogle Scholar
  17. 17.
    Cavanaugh JJ, Lindsey KN, Shilliday BB, Ratner SP. Pharmacist-coordinated multidisciplinary hospital follow-up visits improve patient outcomes. J Manag Care Spec Pharm. 2015;21:256–60.CrossRefPubMedGoogle Scholar
  18. 18.
    Li E, Schleif R, Edelen B. Hospital management of outpatient oncology treatment decisions: a survey to identify strategies and concerns. J Oncol Pract. 2013;9:248–54.CrossRefGoogle Scholar
  19. 19.
    Bulsink A, Imholz AL, Brouwers JR, Jansman FG. Characteristics of potential drug-related problems among oncology patients. Int J Clin Pharm. 2013;35:101–7.CrossRefGoogle Scholar
  20. 20.
    Aimono Y, Nemoto M, Sato W, Saito Y, Aoyama Y, Joko F, et al. Examination of the usefulness of the pharmacists’ outpatient clinic for treatment with oral molecule-targeting drugs. Gan To Kagaku Ryoho. 2013;40:901–5.PubMedGoogle Scholar
  21. 21.
    Cornelison M, Jabbour EJ, Welch MA. managing side effects of tyrosine kinase inhibitor therapy to optimize adherence in patients with chronic myeloid leukemia: the role of the midlevel practitioner. J Support Oncol. 2012;10:14–24.CrossRefPubMedGoogle Scholar
  22. 22.
    Folsche, M. Management of chemotherapy-related symptoms by telephone aftercare by an oncology nurse. Eur. J. Cancer Suppl. 2009; 7(2):231. doi: 10.1016/S1359-6349(09)70790-6 CrossRefGoogle Scholar
  23. 23.
    Bassan F, Peter F, Houbre B, Brennstuhl MJ, Costantini M, Speyer E, Tarquino C, et al. Adherence to oral antineoplastic agents by cancer patients: definition and literature review. Eur J Cancer Care. 2014;23:22–35.CrossRefGoogle Scholar
  24. 24.
    Darkow T, Henk HJ, Thomas SK, Feng W, Baladi JF, Goldberg GA, et al. Treatment interruptions and non-adherence with imatinib and associated healthcare costs: a retrospective analysis among managed care patients with chronic myelogenous leukaemia. Pharmacoeconomics. 2007;25:481–96.CrossRefPubMedGoogle Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2015

Authors and Affiliations

  • Almudena Ribed
    • 1
  • Rosa María Romero-Jiménez
    • 1
  • Vicente Escudero-Vilaplana
    • 1
    Email author
  • Irene Iglesias-Peinado
    • 2
  • Ana Herranz-Alonso
    • 1
  • Carlos Codina
    • 3
  • Maria Sanjurjo-Sáez
    • 1
  1. 1.Gregorio Marañón University General HospitalMadridSpain
  2. 2.Complutense UniversityMadridSpain
  3. 3.Barcelona Clinic University HospitalBarcelonaSpain

Personalised recommendations