Design and evaluation of a documentation system to support the continuity of pharmaceutical care of day-case oncology patients between hospital and community pharmacists

Abstract

Abstract Objective Survey and analysis of pharmaceutical care issues (PCIs) occurring during the course of chemotherapy. Feedback from future users to design and test a documentation system to facilitate information transfer between hospital and community pharmacists. Setting Day-case chemotherapy clinics at the Edinburgh Cancer Centre, community pharmacies providing palliative care services and community pharmacies used by patients recruited to the survey. Method Prospective cross-sectional cohort survey of PCIs in 90 day-case patients receiving chemotherapy. The identified PCIs and the interview transcripts from one-to-one interviews with six local specialist community pharmacists informed the design of the patient medication profile (PMP), the use of which was tested in 20 patients. Two postal questionnaires were used: one to 153 pharmacists in other UK cancer centres/units, one to 20 community pharmacists involved in the testing of the PMP. Key findings Of the 271 recorded PCIs in 90 patients, 41% (112/271) PCIs were identified for the transfer of care and were mostly associated with supportive medication prescribed to manage chemotherapy toxicities. In the testing of the PMP, 88 PCIs were identified in 20 patients and 59% (52/88) of PCIs judged relevant to continuity of care were documented on the PMP and transferred via the patient to community pharmacists together with an information sheet and questionnaire. Seventy-five percent (15/20) of pharmacists replied to the questionnaire, indicating they had followed up 52% (27/52) of all transferred PCIs. ‘Lack of time’ was the only reason given by community pharmacists for not following up PCIs. The majority of community pharmacists thought the information received was useful and increased their contribution to patient care. Conclusion Although oncology patients receive treatment in secondary care, almost half of the associated PCIs require follow-up in primary care between cycles of chemotherapy. The PMP was considered supportive to community pharmacists in the continuity of pharmaceutical care of these patients. The study helped to define the next stage of the development work which requires to define patients' needs and to test a system in practice. Community pharmacists' expectations and requirements must be part of the continuing development of the seamless provision of pharmaceutical care to this patient group.