Impact of comprehensive pharmacy services on patient centered outcomes in a hematology and oncology clinic

Abstract

Background: Growing utilization of oral oncolytics has revealed non-adherence due to expense, side effect profiles, and lack of disease state understanding. Prior analyses have supported the integration of a pharmacist to assist in achieving and maintaining medication adherence.Objectives: Assess the longitudinal impact of a clinic-based pharmacist’s services by evaluating the adherence and overall medication experience of patients in a hematology and oncology clinic.Methods: Patients receiving oral oncolytics via pick-up, same-day or overnight delivery from an academic medical center specialty pharmacy following the integration of a clinic-based pharmacist were included in this quality analysis. Data collection was completed for 5 consecutive months in 2016 and 2017. To objectively assess adherence, the primary outcome was adherence rate measured by the medication possession ratio (MPR) calculated with fill date history. Additional time was dedicated by a clinic-based pharmacist in 2017 to provide outreach, discuss barriers, and develop strategies to improve patient adherence. Secondary outcomes evaluated from the 2017 data included the characterization of adherence barriers and the percent of patients who benefited from pharmacist support.Results: The average MPR for the 2016 and 2017 evaluation periods was 0.99 (n = 58) and 0.97 (n = 91), respectively. There were 41% and 47% of patients, respectively, who had an MPR < 1.00, indicating a medication refill delay. Of those patients, 75% and 77%, respectively, had a refill delay that may have been attributable to prescribed titrations or reductions confirmed via chart review, or medication surplus due to prior early refills outside of each study period. Secondary outcome results from the 2017 evaluation showed 86% of patients self-reported a quantity remaining which correlated directly to their calculated MPR. Barriers to adherence were identified by the pharmacist in 44% of patients with 75% having high copayments or other access issues. Assistance was coordinated by the clinical pharmacist for 100% of patients with financial barriers to accessing their medication. The remaining 25% had side effect concerns potentially impacting their adherence in which the pharmacist provided additional support through side effect management and medication reminder strategies.Conclusions: Our quality analysis supports the continued integration and expansion of clinical pharmacy services, which resulted in maintained medication adherence and improved overall treatment experience, in a hematology and oncology clinic.