ASCO Quality Care 2017: In-House Specialty Pharmacy at Cancer Center Improves Quality of Care, Reduces Medical Errors
An influx of new oral cancer drugs provides patients with a more convenient and less invasive way to take medication, but such treatments are often associated with adherence challenges and medical errors. New research shows that the addition of an in-house specialty pharmacy at a cancer center in New Haven, Connecticut, improved overall quality of care for patients, reduced the amount of time it took patients to receive their medication, and prevented errors associated with filling, dispensing, and taking oral chemotherapy. Adelson et al will present their findings at the upcoming ASCO Quality Care Symposium, taking place March 3 to 4 in Orlando, Florida (Abstract 108).
“Prior to our in-house pharmacy, we had no idea what happened after we sent prescriptions to outside specialty pharmacies,” said lead author Kerin Adelson, MD, Assistant Professor of Medicine and Chief Quality Officer for Smilow Cancer Hospital at Yale New Haven. “Did the patient start treatment later than recommended? Did the patient take the right combination and on a consistent basis? These were all questions that affect quality and outcomes that we were not able to answer before. Now we can.”
Study Findings
Following the creation of a specialty, in-house pharmacy at the Smilow Cancer Hospital in the Yale New Haven Health System, along with treatment protocols for every oral chemotherapy drug, researchers saw dramatic improvements in patient care quality. Patients received medication faster—80% of patients received oral treatments within 72 hours of prescribing. Prior to launching a specialty pharmacy, patients often reported anecdotally that they would wait 2 to 3 weeks to receive medications. In addition, since the launch of the program, pharmacists prevented more than 400 prescription errors.
The authors convened a multidisciplinary task force comprised of physicians, nurses, pharmacists, and patients with the goal of expediting drug access and improving adherence and toxicity monitoring. The team created treatment protocols for every oral oncology drug and embedded them into the medical center’s electronic health record system. All oral oncologic prescriptions were routed to a clinical oncology pharmacist and the specialty pharmacy, where an oncology nurse and pharmacist verified all orders. Pharmacists then placed calls to patients 1, 5, and 21 days after filling an oral prescription to evaluate for toxicity. All processes related to oral chemotherapy were documented on a multidisciplinary flow sheet in the electronic health record that could be accessed by the entire clinical team.
“Patients prescribed oral chemotherapy and other cancer treatments should be supported and monitored with the same vigilance as those patients who receive chemotherapy intravenously in our clinics or in our hospital,” said Howard Cohen BSPharm, MS, FASHP, co-author and Associate Director of Oncology Pharmacy Services at Yale New Haven Hospital. “With our protocol, we are able to better address medication adherence and side effects—all of which translates to a higher quality of care for our patients.”
Researchers were prompted to explore the implementation of a specialty pharmacy after Quality Oncology Practice Initiative (QOPI®) data showed gaps in care quality for oral treatments. QOPI® is an oncologist-led, practice-based quality assessment program designed to promote excellence in cancer care by helping practices create a culture of self- examination and improvement.
Along with a delay in access to medication, researchers found more errors when patients filled their prescriptions elsewhere. Some patients were not taking the right doses or were continuing to receive refills even after their regimen had ended.
The addition of a specialty pharmacy also yielded additional revenue, allowing the not-for-profit cancer center to provide additional services to patients, including the expansion of its medication assistance program. In 2016, an average of 140 patients per month received medication assistance in the form of drug replacement and co-pay support, generally totaling more than $1.5 million per month.
Researchers hope that that their process will serve as a model to other medical institutions seeking to improve quality of care and timely patient access to medication.
“A new model for an in-house specialty pharmacy in a cancer center has led to a significant reduction in prescription errors and the time it takes for patients to receive their medications,” said Don S. Dizon, MD, ASCO Expert and Chair of the Quality Care Symposium News Planning Team. “The cost savings that resulted from this collaborative, patient-centered approach for oral chemotherapy were then redirected to patient education, monitoring, and assistance.”
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
