Health care practitioner prescribing patterns and perspectives on oral chemotherapy management: A survey of cancer centers in Toronto, Canada.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 48-48
Author(s):  
Mark Pasetka ◽  
Larissa Day ◽  
Maggie Ford ◽  
Angela Boudreau ◽  
Angie Giotis ◽  
...  
Keyword(s):  
Side Effects ◽  
Patient Education ◽  
Oral Cancer ◽  
Patient Adherence ◽  
Oral Chemotherapy ◽  
Cancer Therapies ◽  
Prescription Practices ◽  
Toxicity Monitoring ◽  
Improve Patient Adherence ◽  
Improve Patient

48 Background: With an increasing number of patients receiving oral cancer therapies, evaluation of safe prescription practices, effective patient education, and toxicity monitoring of these agents is imperative. Methods: Multi-disciplinary oncology practitioners at several cancer centres in Toronto, Canada were surveyed using a web-based platform, to evaluate their prescription practices, use of patient education and symptom management tools, as well as their views on patient adherence and toxicity reporting. Results: Of 170 respondents, 43% were nurses, 34% were pharmacists, and 23% were physicians. Seventy nine percent considered patient education, medication adherence (76%), and toxicity management (78%) as “very important” components of oral chemotherapy management. Prescription methods varied: 59% of respondents used written prescriptions, 39% computerized physician order entry (CPOE), and 0% pre-printed orders, ≥50% of the time. Clinicians felt that patients report side effects from oral agents only “some of the time” (53%), and the most problematic toxicities were nausea (61%) and diarrhea (61%). Practitioners perceived the most common reasons for patient underreporting of side effects to be “fear of treatment interruption” (62%), and that “toxicities are part of the treatment” (66%). Seventy three percent of those surveyed felt individual counseling, follow-up calls (69%), and updated medication information (57%) would improve patient adherence and safety. Conclusions: A diverse group of surveyed oncology professionals expressed the importance of utilizing educational and toxicity monitoring tools for patients on oral cancer therapies, particularly as patients are thought to under-report symptoms. Prescription practices are variable, and CPOE use should be improved. The results of this survey will also be compared to a patient survey, to help develop better tools and policies to standardize practice, and improve patient adherence and toxicity management on oral cancer agents.

Barriers to Deprescribing

2019 ◽  
pp. 47-68
Author(s):  
Swapnil Gupta ◽  
Rebecca Miller ◽  
John D. Cahill
Keyword(s):  
Side Effects ◽  
Patient Adherence ◽  
Medical Institution ◽  
Sociocultural Factors ◽  
Related Factors ◽  
Potential Patient ◽  
Improve Patient Adherence ◽  
The Relationship ◽  
Improve Patient

This chapter identifies the possible barriers to deprescribing, and presents suggestions for strategies to overcome them. Although deprescribing has the potential to streamline medication regimens, minimize side effects, cut costs, improve patient adherence, and strengthen the relationship between the patient and the prescribing professional, barriers may originate from the patient, physician, and/or the institution, both local and the larger medical institution. Barriers related to prescriber-related factors such as the physician’s illusion and fear of litigation, are discussed. Potential patient- and environment-related barriers are also discussed, including sociocultural factors which may emerge in the process of initiating a course of deprescribing. Included in this chapter is a discussion of the possibility of relapse, colloquially defined, and the patient’s and provider’s fears for rehospitalization. Possible strategies for overcoming each of these barriers are discussed.

Management of HIV-1 Infection in Adults and Adolescents

2000 ◽  
Vol 13 (6) ◽  
pp. 426-441 ◽  
Author(s):  
Kenneth R. Eugenio ◽  
Caroline S. Zeind
Keyword(s):  
Highly Active Antiretroviral Therapy ◽  
Patient Adherence ◽  
Social Barriers ◽  
Highly Active ◽  
Immunodeficiency Virus ◽  
Improve Patient Adherence ◽  
Substantial Decline ◽  
Improve Patient ◽  
Hiv 1 ◽  
New Strategies

The management of Human Immunodeficiency Virus-1 (HIV-1) infection has undergone dramatic change since its initial identification. Advances have occurred in drug development, viral pathology understanding, laboratory monitoring and genetic analysis. With the advent of highly active antiretroviral therapy (HAART), there has been a substantial decline in HIV-1-related morbidity and mortality. Today, HIV-1 infection is treated as a chronic disease that requires strict patient adherence to HAART. Pharmacists provide pharmaceutical care to patients with HIV disease in a variety of ways, and they can improve patient adherence rates. Current therapeutic strategies have not resulted in eradication of HIV-1 infection. Present and future therapeutic challenges include viral resistance, reservoirs of virus and drug toxicities. Globally, the spread of HIV-1 infection continues at an alarming rate, and economic and social barriers may limit access and success of HAART. New strategies and novel approaches in managing HIV-1 infection continue to be developed in an effort to cure and eradicate this disease.

Adherence measurement and patient recruitment methods are poor in intervention trials to improve patient adherence

2014 ◽  
Vol 67 (10) ◽  
pp. 1076-1082 ◽  
Author(s):  
Rebecca A. Jeffery ◽  
Tamara Navarro ◽  
Nancy L. Wilczynski ◽  
Emma C. Iserman ◽  
Arun Keepanasseril ◽  
...  
Keyword(s):  
Patient Adherence ◽  
Patient Recruitment ◽  
Recruitment Methods ◽  
Adherence Measurement ◽  
Improve Patient Adherence ◽  
Intervention Trials ◽  
Improve Patient

Designing a multidisciplinary oral chemotherapy education and monitoring program.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 146-146
Author(s):  
Sharon Lane ◽  
Kimmie Ng ◽  
Robin Sommers ◽  
Carole Kathleen Dalby ◽  
Susanne Conley ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Side Effects ◽  
Patient Education ◽  
Monitoring Program ◽  
Oral Chemotherapy ◽  
Teaching Session ◽  
Dosing Schedule ◽  
Safety Risks ◽  
Adherence Monitoring ◽  
Satisfaction Surveys

146 Background: In 2013 ASCO and ONS published guidelines to promote safe practices for oral chemotherapy use. These agents can have significant toxicities and pose safety risks without proper adherence. Guided by the ASCO/ONS recommendations, Dana-Farber Cancer Institute (DFCI) designed a program to provide comprehensive patient education and adherence monitoring. Methods: To address patient safety risks associated with oral chemotherapy use, a multidisciplinary team assembled to design a process for timely and appropriate patient education and adherence monitoring. Physicians, Nurse Practitioners or Physician Assistants initiate education by reviewing the dosing schedule, side effects and providing a standard education sheet. Within 24 hours, a pharmacist contacts the patient and completes a teaching session utilizing a template based upon the MOATT Tool, a teaching tool developed by the Multinational Association of Supportive Care in Cancer. The MOATT Tool includes a review of the dosing schedule, side effects and management, drug handling, drug/food interactions and practice contact information for questions. Lastly, within five days of therapy initiation, a nurse calls the patient to reinforce education and to assess toxicity and adherence. To evaluate the effectiveness of the program, chart audits and patient satisfaction surveys were conducted. Results: To date 78% of patients started on oral chemotherapy have received a teaching session and 73% have received a follow up adherence call. Patient satisfaction surveys conducted demonstrate that 100% (N=12) of patients strongly agreed with the following statement; “following my counseling session with the Dana-Farber pharmacist, I understood how and when to take my oral chemotherapy medication(s)” and 94% agreed with the statement; “overall I feel that the oncology nurse phone session provided me with useful information.” Conclusions: Implementing a standard patient education and adherence monitoring program for patients initiating oral chemotherapy is essential to guarantee safe patient care. Compliance monitoring at the disease and provider level is necessary to ensure continual quality improvement.

To Improve Patient Adherence to Drug Regimens: An Interdisciplinary Approach

1978 ◽  
Vol 78 (7) ◽  
pp. 1216 ◽  
Author(s):  
John A. Romankiewicz ◽  
Vincent Gotz ◽  
Ann Capelli ◽  
Herbert S. Carlin
Keyword(s):  
Patient Adherence ◽  
Interdisciplinary Approach ◽  
Drug Regimens ◽  
Improve Patient Adherence ◽  
Improve Patient
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