Collaborative Management Program Research Articles

Pharmacist-Urologist Collaborative Management Improves Clinical Outcomes in Patients With Castration-Resistant Prostate Cancer Receiving Enzalutamide.

Background: Enzalutamide is useful for the treatment of castration-resistant prostate cancer (CRPC). Despite its usefulness, adverse events (AEs) sometimes force patients to discontinue treatment. To maximize patient care, we developed an ambulatory care pharmacy practice that allows collaboration between a pharmacist and urologist to manage patients with CRPC receiving enzalutamide. In this study, we investigated the efficacy of this collaborative management. Methods: A retrospective chart review of 103 patients with CRPC receiving enzalutamide in our hospital between May 2014 and December 2020 was performed. Our collaborative management was implemented in October 2016. Before being examined by urologists, patients visited the oncology pharmacy consultation room for a face-to-face consultation, wherein the oncology pharmacists assessed factors such as adherence to enzalutamide, any AEs and their grades, and provided their suggestions to the urologists. The time to enzalutamide discontinuation and prostate-specific antigen progression were compared between patients who started enzalutamide before (n = 41) and after (n = 62) the implementation of the collaborative management. A multivariate Cox regression analysis was performed to analyze the factors associated with enzalutamide discontinuation. Results: After implementing collaborative management, the pharmacists had 881 patient consultations. Among the 476 suggestions from pharmacists, 345 were accepted by urologists. The most frequent suggestion was supportive care in enzalutamide treatment (224 suggestions). Multivariate analysis showed that collaborative management [hazard ratio (HR) 0.53, 95% confidence interval (CI) 0.31–0.89, p = 0.017] and higher prostate-specific antigen (PSA; HR 2.41, 95% CI 1.36–4.28, p = 0.003) were significantly associated with enzalutamide discontinuation. The median time to discontinuation (18.9 vs. 7.6 months, p = 0.012), time to discontinuation due to AEs (not reached in both groups, p = 0.001), and time to PSA progression (13.3 vs. 5.8 months, p = 0.002) were all significantly longer in the after group. Conclusions: We implemented a pharmacist-urologist collaborative management program for outpatients with CRPC receiving enzalutamide. The results revealed that collaborative management was useful for prolonging the time to enzalutamide discontinuation.

Impact of a pharmacy‐cardiology collaborative management program during initiation of antiarrhythmic drugs

AbstractObjectiveAntiarrhythmic drugs (AADs) are commonly used for management of atrial fibrillation and other cardiac arrhythmias. However, the use of AADs in clinical practice is challenging due to the risk of serious adverse drug events associated with these medications. Adherence to recommended monitoring parameters may improve safety in these agents. The primary objective of this study was to determine the effectiveness of a pharmacy‐cardiology collaborative approach to AAD management.MethodsThis retrospective cohort study was conducted to assess AAD management with a pharmacy‐cardiology collaborative program compared with usual care in a United States Department of Veterans Affairs (VA) medical center.ResultsNinety patients were included for evaluation; 40 in the preintervention group and 50 in the postintervention group. Complete recommended baseline monitoring parameters were obtained for 29 patients (72.5%) in the preintervention group and 47 patients (94%) in the postintervention group (P < .01). There were significantly more clinical interventions (P < .01) in the postintervention group, including AAD dose adjustment or discontinuation, interacting medication dose adjustment or discontinuation, electrolyte supplementation, monitoring ordered, and total interventions.ConclusionThe study results demonstrate a statistically significant improvement in adherence to recommended baseline monitoring parameters with a greater number of clinical interventions when a pharmacy‐cardiology collaborative AAD management program was involved compared with usual care. The increased interventions and improved adherence to monitoring parameters may allow for safer use of these agents.

Lessons learnt from a collaborative management programme in coastal Tanzania

The Tanga Coastal Zone Conservation and Development Programme, initiated in 1994, was among the first such projects to make livelihoods improvement a key objective, and to use a community-based approach. It developed an approach to coastal management planning that is broadly satisfactory to both communities and the government. Six fisheries management areas and two mangrove management areas were established. Institutional arrangements for the collaborative approach were strengthened and community leaders and local government officers were trained in a range of relevant skills. A coastal environmental education programme for primary schools involved several thousand schoolchildren, and a gender programme built the confidence of women. Implementation of the management measures was noticeably harder than planning, particularly elimination of destructive fishing methods. Fishers and coastal communities now however have a much greater involvement in, and understanding of, coastal management and consequently a greater sense of ownership.

Attitudes and preferences toward co-operative agreements for management of private forestlands in the North-eastern United States

Forest fragmentation is increasing throughout much of the United States. Co-operative management agreements are a potential solution to this problem and this case study suggests that non-industrial private landowners in the North-eastern United States are as likely to undertake collaborative management programs as they are to undertake the same management programs independently. However, the probability of undertaking any of the management programs examined in this study was low, suggesting that incentives for co-operative management between landowners may be needed. And, regardless of whether management is co-operative or independent, the estimated probability of program adoption is higher when management focuses on amenities, such as wildlife habitat, compared to timber harvests.