Providing uninterrupted oral oncolytic therapies during the COVID-19 pandemic.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 226-226
Author(s):  
Edward Arrowsmith ◽  
Rachel L. Mitchell ◽  
Jack L. Taylor ◽  
Stephen Matthew Schleicher ◽  
Natalie R. Dickson ◽  
...  
Keyword(s):  
Insurance Coverage ◽  
Home Delivery ◽  
Pharmacy Staff ◽  
Cost Share ◽  
Grant Support ◽  
Number Of Patients ◽  
Specialty Pharmacy ◽  
Time Periods ◽  
Comparison Table ◽  
Oral Oncolytics

226 Background: Uninterrupted utilization of oral oncolytics is critical to maximizing safety and efficacy of cancer treatment. The COVID-19 pandemic presented numerous challenges to delivering a continuous and safe supply of oral oncolytics to patients with cancer including potential loss of insurance coverage, patient lost income making copays more difficult, remote pharmacy staffing difficulties, and logistical challenges in safely distributing drug to cancer patients. Tennessee Oncology has an in-house Specialty Pharmacy that utilizes home delivery of oral oncolytics while coordinating care with providers during changing patient situations. Methods: We analyzed patients who received an oral oncolytic from our pharmacy in two periods: January-May 2019 and January-May 2020. We compared the aggregate patient copay amounts during these periods, the number of patients who utilized copay assistance or foundational financial support. For insights on continuation we also assessed the medication possession ratios (MPR, the sum of the day’s supply for all fills of a given drug in a particular period divided by the number of days in that period) during these time periods for five of our most commonly dispensed drugs. Results: The aggregate patient copay was similar between the two time periods. A 22% increase in the utilization of copay cards indicated patient’s insurance coverage was sustained. We also observed a 12% increase in the number of patients utilizing foundation support for prescriptions filled. MPRs for five commonly dispensed oral oncolytics were unchanged during COVID-19. Conclusions: Our in-house specialty pharmacy maintained delivery of oral oncolytics during the COVID-19 pandemic. Patient cost share was contained by our pharmacy staff proactively utilizing copay cards for all eligible patients and diligently securing foundational grant support. The pharmacy interventions allowed for affordability, uninterrupted pharmacy operations, and consistent medication supply. This led to continued medication adherence. MPR for the 5 top dispensed medications was consistent in a year-on-year comparison. [Table: see text]

The effects of COVID-19 on new oral oncolytic treatments.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 102-102
Author(s):  
Rachel L. Mitchell ◽  
Edward Arrowsmith ◽  
Jack L. Taylor ◽  
Stephen Matthew Schleicher ◽  
Natalie R. Dickson ◽  
...  
Keyword(s):  
Patient Education ◽  
Oral Therapy ◽  
Turnaround Time ◽  
Patient Volume ◽  
Order Entry ◽  
Seamless Care ◽  
Number Of Patients ◽  
Measured Time ◽  
Specialty Pharmacy ◽  
Oral Oncolytics

102 Background: Dependable and timely dispensing and delivery of oral oncolytics to patients with a new indication for therapy is a central part of modern cancer care. The COVID-19 pandemic has presented numerous impediments and challenges to patients receiving oral therapy from many specialty pharmacies in a timely due to remote pharmacy staffing and drug shipment. Tennessee Oncology has an integrated URAC and ACHC accredited Specialty Pharmacy to ensure the seamless care for our patients prescribed oral oncolytics. We investigated the effect of COVID-19 on the number of patients initiating care with an oral oncolytic and the time to fill during the pandemic. Methods: We analyzed the number of overall new patients to the practice and new patients receiving oral oncolytics in two year-to-year comparisons: (1) January-March 2019 vs. January-March 2020 and (2) April-May 2019 vs. April-May 2020. We then compared the average pharmacy turnaround time (defined as the time of entry of a regimen in the electronic medical record that contained an oral oncolytic until the time that prescription was ready for shipment) and the average time from regimen entry until the patient received that medication. Prescriptions received and filled on the day of order entry were recorded as a one-day turnaround time. Results: A year to year increase of 7% in practice new-patient volume was associated with a 13% increase in new oral oncolytic patients from January-March 2020. Year to year April and May comparisons, noted a 33% decrease in new-patient volume to our practice with an associated 10% decrease in new oral oncolytic patients. Time to fill remained consistent in March and April 2020 at 1.84 days vs. 1.78 for 2019. The time from regimen entry to patient shipment receipt was also stable year to year (3.10 vs. 3.06 days). Conclusions: Our in-house Specialty Pharmacy was able to continue delivery of new prescriptions for oral oncolytics during the COVID-19 pandemic. There was a fall in the number of new patient dispensing in April-May 2020 that we attribute to a decrease in cancer diagnoses related to COVID-19 as reflected by a fall in total practice new patients. New patient on-boarding activities including prior authorizations, co-pay assistance, patient education were maintained and the measured time to fill from regimen entry to patient receipt were unchanged.

scholarly journals Patients’ expectations on medicines information

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Sevikyan ◽  
I Kazaryan
Keyword(s):  
Storage Conditions ◽  
Community Pharmacies ◽  
Duration Of Treatment ◽  
Pharmacy Staff ◽  
Medicine Price ◽  
Expiry Date ◽  
Face To Face ◽  
Medicines Information ◽  
Number Of Patients ◽  
Effective Use

Abstract Background Medicines information is important for patients as it assists them in achieving more safe and effective use of pharmaceuticals. Many patients seek information from community pharmacies' staff. The objectives of this study were to identify specific topics of medicines information which patients expect to receive at community pharmacies. Methods Face-to-face interviews were conducted with 1059 visitors of community pharmacies in Armenia. Previously developed questionnaire was used for interviewing patients. Data were analysed with the SPSS statistical software. Results Most of participants acknowledged importance of receiving from community pharmacies' staff information on therapeutic indications of medicines (91.1%), dosage and method of administration (90.8%), the duration of treatment (86.3%), expiry date (85.7%), adverse reactions (85.0%), contraindications (84.6%), storage conditions (77.5%) and type of activity (76.0%). Importance of receiving information on some specific topics depends on patients' age. Participants' acknowledgement of information on interaction with other medicines, certain categories of users, and potential effects on the ability to drive is decreasing with patients' age increasing (p < 0.001). The opposite trend was observed with attitude to receiving information on medicine price that was mostly valued by elderly patients (p = 0.046). The number of patients who trust the information provided was higher among those who more often received comprehensive responses from pharmacists and pharmacy assistants (p < 0.001). Conclusions Receiving medicines information from the staff of community pharmacies is important for patients, and the majority of them trust to information received. Patients are mainly provided with comprehensive responses to their questions about medicines, and there was dependence between a frequency of receiving comprehensive responses and a level of patients' trust the information provided by pharmacy staff. Key messages Increasing patients’ awareness on their right to get medicines information can be beneficial. Comprehensive responses increase patients trust medicines information provided by pharmacists.

scholarly journals Implementation and effectiveness of drive-through medication pick-up and home delivery services. A patient safety initiative during COVID-19 pandemic

2021 ◽  
pp. 251604352110090
Author(s):  
Haneen K AlAbbasi ◽  
Shabeer A Thorakkattil ◽  
Syed I Mohiuddin ◽  
Habib S Nemr ◽  
Rita Jabbour ◽  
...  
Keyword(s):  
Patient Safety ◽  
Implementation Process ◽  
Home Delivery ◽  
Successful Implementation ◽  
Social Distancing ◽  
Pharmacy Department ◽  
Ensure Patient Safety ◽  
Number Of Patients ◽  
Delivery Services ◽  
Safety Initiative

Introduction With the emergence of the first COVID-19 case in Saudi Arabia, Johns Hopkins Aramco Healthcare has immediately executed the appropriate protocols in response to this severe global crisis. The pharmacy department at Johns Hopkins Aramco Healthcare continues to play an essential role in providing the safest, efficient, and effective service to its eligible patients. In response to the COVID-19 pandemic, the pharmacy department acted by implementing a drive-through pharmacy and home delivery services as new person-centered services to ensure patient safety. These two new services were initiated to protect both the pharmacist and the patient from COVID-19 infections as they ensure social distancing and reduce patients’ visits to the walk-in pharmacies, hence providing valuable and convenient services during this pandemic. Objective This article aims to describe the implementation processes and effectiveness of drive-through medication pick-up and home-delivery services as a patient safety initiative during the COVID-19 pandemic. Method The implementation process of the drive-through and home delivery services are explained in detail. The utilization of these two services is evaluated by measuring the number of patients and prescriptions between April 2020 and August 2020. Result The increased utilization of drive-through medication pick-up and home delivery services in terms of the number of patients and prescriptions ensures patient safety by minimizing infection risk. Conclusion The increase in the utilization of drive-through medication pick-up and home delivery services reflects its successful implementation during the COVID-19 pandemic. Both services meet the pandemic’s social-distancing requirements and minimize risks of infections, which will ensure patient safety during the COVID-19 pandemic.

Academic Detailing of Meperidine at a Teaching Hospital

2003 ◽  
Vol 38 (1) ◽  
pp. 30-35 ◽  
Author(s):  
Lisa A Boothby ◽  
Lih-Jen Wang ◽  
Susan Mayhew ◽  
Lynn Chestnutt
Keyword(s):  
Pain Management ◽  
Teaching Hospital ◽  
Immediate Release ◽  
Prescribing Patterns ◽  
Relative Reduction ◽  
Academic Detailing ◽  
Pharmacy Staff ◽  
Prescribing Behavior ◽  
First Line Therapy ◽  
Number Of Patients

Meperidine (Demerol) is an opiate analgesic that is not considered first-line therapy for most pain management indications because of concerns about its safety and efficacy. Inpatient data from a 417-bed community teaching hospital revealed high use of meperidine in oral, IM, and IV forms. A multifaceted academic detailing approach was employed to change prescribing behavior and decrease meperidine use. This approach included conducting two concurrent Medication Use Evaluations; Grand Rounds presentations for pharmacy staff, nurses, and medical residents; solicitation of opinion leaders; pocket and table-top cards; newsletter articles; and provision of pharmaceutical care. Comparing the number of meperidine doses dispensed per adjusted patient day before and after the intervention, use was reduced by 0.0966 doses per patient (P < 0.05: 95% CI, 0.0955 to 0.0977). The number of patients receiving meperidine was reduced by 2.43% (P < 0.05: 95% CI, 1.97 to 2.88). This translates into a relative reduction of 29.5% in patients receiving meperidine and a relative reduction of 31% in meperidine doses dispensed per patient after academic detailing initiatives vs before. Eighty-five percent of standard orders were changed to improve therapy; these changes included converting meperidine to morphine or hydromorphone, decreasing cumulative acetaminophen daily dosages, using controlled-release and immediate-release opioids for pain management when oral therapy was tolerated, and combining modalities with different mechanisms of action for synergy and to decrease potential adverse effects from larger dosages of single entities. Academic detailing of meperidine resulted in short-term changes in prescribing patterns and decreased meperidine use at this institution. Long-term implications for pain management have not yet been assessed.

scholarly journals Implementation of an internal check of oral oncolytics: a single-center, specialty pharmacy safety initiative

2019 ◽  
Vol 8 (sup1) ◽  
pp. 25-25
Author(s):  
Mitchell Hughes ◽  
Richard Kriska ◽  
Gregory Strong ◽  
Jennifer Chung ◽  
Lily Nguyen ◽  
...  
Keyword(s):  
Single Center ◽  
Internal Check ◽  
Specialty Pharmacy ◽  
Oral Oncolytics ◽  
Safety Initiative

543 DISSEMINATION AND SAFETY OF ROBOT-ASSISTED ESOPHAGECTOMY IN JAPAN

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
T Nishigori ◽  
K Obama ◽  
N Ichihara ◽  
I Uyama ◽  
M Inomata ◽  
...  
Keyword(s):  
Operative Mortality ◽  
Insurance Coverage ◽  
Current Status ◽  
Robot Assisted ◽  
Case Volume ◽  
Web Based ◽  
Invasive Esophagectomy ◽  
Number Of Patients ◽  
New Procedures ◽  
Universal Health

Abstract   Robot-assisted surgery for gastrointestinal cancers began to be covered by universal health insurance in April 2018 in Japan. However, the current status of this new procedures such as the number of patients and clinical outcomes was unclear. The aim of this study to retrospectively examine the dissemination and safety of robot-assisted esophagectomy (RAE) in Japan using a nationwide web-based database, or the National Clinical Database (NCD). Methods The study included patients who underwent RAE or conventional minimum invasive esophagectomy (MIE) and were registered in the NCD in 2018. The outcomes were operative mortality and the numbers of hospitals and surgeons performing the surgeries. Results The number of patients undergoing RAE and MIE was 122 and 4799, respectively. RAE was performed at 28 hospitals by 37 surgeons, while MIE was done at 523 hospitals by 837 surgeons. In terms of annual case volume per hospital, RAE was likely to be performed in higher volume centers. The number of patients undergoing RAE per month in Japan was less than 5 before insurance coverage began. It has increased to more than 10 since April. Operative mortality occurred in 2 (1.6%) patients following RAE, while it occurred in 78 (1.6%) following MIE. Conclusion RAE was safely introduced in Japan. The number of patients undergoing RAE and surgeons and hospitals performing it were gradually increasing but still limited.

Care coordination for oral oncolytics through pharmacy integration and cycle 1-day 1 documentation.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 260-260
Author(s):  
Nancy Walker Peacock ◽  
Stacey McCullough ◽  
Jared Crumb ◽  
Leah Owens ◽  
Laura Kaufman ◽  
...  
Keyword(s):  
Process Improvement ◽  
Treatment Plan ◽  
Processing System ◽  
Subsequent Treatment ◽  
Pharmacy Staff ◽  
Drug Counseling ◽  
Medical Oncologists ◽  
Treatment Plans ◽  
Oral Oncolytics

260 Background: The growing number of oral oncolytic therapies (OOTs) necessitates a standardized EMR workflow that integrates pharmacy activities for dispense and patient management and standardizes cycle-1/day-1 (C1D1) documentation. Our practice’s treatment plans contain appropriately timed OOT follow-up activities including labs, physician follow-up visits, and pharmacy calls for toxicity and adherence checks, however complications in prescription fulfillment such as prior authorization, co-pay assistance, or inability of in-practice pharmacy to dispense limit the predictability of C1D1 dates of OOTs. Methods: An EMR query identified patients at a single clinic location of 5-medical oncologists (MDs) for whom oral oncolytic treatment plans were entered from January 1 to June 30, 2018. C1D1 date entered by the MD in the EMR was compared to the pharmacy processing system dispense date. Ten patients were identified, and 10% (1/10) had an accurate C1D1 documented within the EMR. As part of the ASCO Quality Training Program, to improve the accuracy of C1D1 documentation, a new workflow was implemented whereby: (1) a “hold” activity was added to new EMR treatment plans so that C1D1 remained pending until patients had received medication; (2) clinic checkout staff provided patients with information on the in-practice pharmacy and expectations for next steps; (3) pharmacists utilized existing reporting tools to identify newly entered treatment plans and transcribed orders into e-prescriptions sent to our practice pharmacy; (4) the pharmacy workflow ensued with pharmacy staff leading patient engagement, drug counseling; (5) pharmacists confirm C1D1, document within EMR (6) subsequent treatment plan activities were scheduled. Results: Following education and process changes within the clinic and pharmacy, accurate C1D1 documentation occurred in 90% (9/10) of patients initiating OOTs. Conclusions: Including pharmacy fulfillment time in EMR workflow can improve C1D1 documentation accuracy and associated management of OOTs. Education regarding roles and processes of prescribing MDs, pharmacy staff and clinic staff will be required to scale this process improvement throughout the organization.

Pharmacist-driven oral oncolytic medication education and consent.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 44-44
Author(s):  
Bernard Tawfik ◽  
Harmony Bowles ◽  
Zoneddy R. Dayao ◽  
Richard C. Lauer ◽  
Janet Abernathy
Keyword(s):  
Patient Education ◽  
Patient Adherence ◽  
Consent Process ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Consent Rate ◽  
Pharmacy Staff ◽  
University Of New Mexico ◽  
Oncolytic Therapy ◽  
Oral Oncolytics

44 Background: The number and type of oral oncolytic therapy in oncology is expanding rapidly. Oral oncolytics have serious side effect potential and patient education has been shown to reduce adverse events. Pharmacist driven interventions have been shown to safety and adherence. The University of New Mexico Comprehensive Cancer Center (UNM CCC) initiated and then improved upon a pharmacist driven patient education and consent process for oral oncolytic therapy. Methods: A pharmacist driven education and consent process was initiated at UNM CCC and monitored from August 2016 to October 2018. The intervention initially used a message generated by an order in the Electronic Medical Record (EMR) to alert the pharmacist of new oral oncolytic prescriptions. Initial uptake by providers was low so education regarding this order was presented to providers. Outpatient pharmacy staff were instructed not to release first fill oral oncolytic prescriptions without notifying the pharmacist educator. Lastly, hematology and oncology fellows notified the pharmacist educator of patients discharged directly from the hospital with a new oncolytic prescription. The metric measured was the percent of patients on oral oncolytic therapy who were educated and consented by the pharmacist for oral oncolytic medications filled at UNM CCC. Statistical analysis included run charts with 95% Confidence Intervals and t-tests with two tails, assuming unequal variation between groups and an alpha of 0.05. Results: The initial monthly education and consent rate was 17.9% followed by 45.5% the following month. This quickly grew to an average of 87.0% (95% CI 55.7-118.2) for the subsequent 15 months which achieved control. Additional changes were made as part of the PDSA cycle which increased the education rate to 95.7% (95% CI 84.4-107.1). These two periods were statistically significantly different (p = 0.0025). Conclusions: A pharmacist driven program for education and consent upon initiation of oral oncolytics is possible and can successfully educate the majority of patients. Future expansions of this program will include ensuring patient adherence and educating patients who fill oral oncolytics outside UNM CCC.

Admissions for Stroke and Strategies to Optimize Healthcare Delivery During the COVID-19 Pandemic - Experience from a Tertiary Care Hospital in South India

2021 ◽  
Vol 8 (36) ◽  
pp. 3300-3305
Author(s):  
Kevin John John ◽  
Rhea Anne Roy ◽  
Bincy Baby ◽  
Deep P. Pillai ◽  
Anilkumar Sivan ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Hospital Admissions ◽  
Tertiary Care ◽  
Care Hospital ◽  
Hospital Type ◽  
Stroke Incidence ◽  
Nihss Score ◽  
Number Of Patients ◽  
Significant Difference ◽  
Time Periods

BACKGROUND COVID-19 is associated with a hypercoagulable state and stroke is one of its most common neurological complications. The current study is aimed at investigating the effect of the COVID-19 pandemic on hospital admissions for stroke. METHODS We conducted a retrospective observational study to determine if there was a significant difference in the number of hospital admissions for stroke during the 2 months of lockdown and the two preceding months, (starting on 24 March 2020). The numbers were also compared with the figures during the same months in the previous year. The numbers were also compared to the same months one year prior. The secondary objectives were to compare the time between the onset of stroke and presentation to the hospital, type of strokes that presented to the hospital, severity of stroke, number of code activations, number of thrombolysis conducted, and in-hospital mortality between the same time periods. RESULTS The total number of patients admitted for stroke during the time periods from 25th March 2019 to 24th May 2019, 25th January 2020 to 24th March 2020 and 25th March 2020 to 24th May 2020 were 82, 72 and 75 respectively, and there was no statistically significant difference between these numbers. However, there was a significant increase in the proportion of stroke cases when compared to total hospital admissions. This suggests that an increase in stroke incidence may have been masked by a reduction in the total number of patients presenting to the hospital. The National Institutes of Health Stroke Scale (NIHSS) score of the patients who presented during the lockdown were higher. There were no significant differences in the time between the onset of stroke and presentation to the hospital, type of strokes that presented to the hospital, severity of stroke, number of code activations, number of thrombolysis conducted, and in-hospital mortality between the periods under study. CONCLUSIONS The present study suggests that there may be a relative increase in the incidence of stroke in the community, as a result of the COVID-19 pandemic. The patients who presented with stroke during the lockdown period had a higher NIHSS score. KEYWORDS COVID-19, Stroke, Lockdown

Implementation of an oral chemotherapy adherence tool at an NCCN comprehensive cancer center.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 265-265
Author(s):  
Peter D. Whooley ◽  
Fumei Cerecino ◽  
Joy Kaye Weaver ◽  
Maria Market ◽  
Marie Riehl ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Critical Factor ◽  
Dose Schedule ◽  
Clinic Visit ◽  
Oral Chemotherapy ◽  
Oncologic Outcomes ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Number Of Patients ◽  
Specialty Pharmacy

265 Background: Adherence to oral chemotherapy (OC) is a critical factor in achieving optimal oncologic outcomes. Correct dosing, education, and symptom management are essential to maximizing adherence. As part of the 2020 Quality Oncology Practice Initiative Certification Program Fox Chase Cancer Center (FCCC), a NCCN Comprehensive Cancer Center, learned that only 33% of patients on OC had a documented OC plan, 7% were assessed for adherence, and 0% had documentation reflecting efforts to address non-adherence. Methods: Our goal was to create and implement an electronic medical record (EMR) tool (Oral Chemo Smart Form) to address the variance and deficiencies in monitoring adherence to OC. The Smart Form (SF) was designed to include fields to document the OC plan (drug, indication, dose, schedule, duration of cycle, initial start/end date) as well as provide a standard for documentation of education, management of toxicity and non-adherence. We integrated the SF into nursing, pharmacy, and physician workflows to capitalize on shared EMR tools. A series of Plan-Do-Study-Act cycles were conducted over 8 weeks within pilot clinics. Weekly review of the SF and feedback forms generated real-time progress reports which were serially appraised and shared with stakeholders. Results: Two oncologists (piloted in Genitourinary and Breast Cancer clinics), two pharmacists, and several nurses used the SF March 15, 2021 to May 7, 2021. Over these 8 weeks, 223 patients on OC were seen in clinic. If the OC was dispensed from FCCC, pharmacists were to complete the SF at the time of initial OC prescription, 7 days after dispensing, and with each refill. Pharmacists also identified patients receiving OC through a specialty pharmacy and routed a message to clinic nurses via an EMR message pool. The message became the trigger for nurses to call patients within two weeks to troubleshoot dispensing issues and/or complete the SF. Oncologists were to complete the SF with each clinic visit for a patient on OC. Feedback from the clinical and pharmacy teams motivated changes in the content fields of the SF and workflow. Ultimately, 45% of patients on OC had the SF completed. An OC plan was documented in 41% of patients, compared to 33% at baseline; 87% had an administration schedule compared to 81%. There was an increase in the number of patients contacted following start of OC, 35% from 4%. Medication adherence was assessed in 35% of patients, up from 7%. Documented discussions addressing medication adherence increased to 78%, from 0%. Conclusions: Introduction of the Oral Chemo SF in pilot clinics improved documented OC plans and administration schedules. Its use introduced a standard process for monitoring safety, assessing and addressing non-adherence, while troubleshooting specialty pharmacy dispensing issues. The SF will be implemented throughout FCCC and further evaluated with efforts focused on adopting and streamlining this as standard work.

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