Implementation and outcomes of a pharmacist-led oral chemotherapy clinic at VA Maine Healthcare System

Abstract

Background

Patients undergoing intravenous chemotherapy tend to receive more structured follow-up and closer monitoring than those taking oral chemotherapy. The management of oral chemotherapy at our facility was historically segmented and weighed heavily on veteran self-advocacy. It was hypothesized that routine check-ins with a clinical pharmacy specialist with a scope of practice would allow for a more proactive, supportive approach to care.

Objective

The primary purpose of this quality improvement project is to ascertain the impacts of a pharmacist-led oral chemotherapy clinic at the VA Maine Healthcare System. Methods: Starting January 7, 2019, all patients filling an oral medication(s) for cancer treatment were considered for enrollment into the pharmacist-run clinic at the time of medication approval. The pharmacist contacted each patient by phone at patient-specific intervals determined by drug-specific lab monitoring requirements, side effect prevalence, refill due date, and overall patient preference. The total number of interventions was tallied by intervention category. Medication adherence was assessed as a secondary outcome by comparing medication possession ratios preclinic and postclinic implementation.

Results

From January 7, 2019, to January 5, 2020, there were a total of 698 interventions made by the clinical pharmacist. These impacts are a composite of pharmacologic (n = 141), nonpharmacologic (n = 115), and surveillance (n = 442) interventions. Medication possession increased from 92% to 96% (p < 0.05).

Conclusion

A pharmacist-led oral chemotherapy clinic allows for a variety of clinically significant interventions and improved monitoring of patients on oral anticancer medication(s). Providing proactive follow-up with a scoped pharmacist improved medication compliance and improved the quality of care for our veterans.