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Pharmacists make oncology and transplant patients happier?
DEPARTMENTS Journal of the American Pharmacists Association 56 (2016) 696
Contents lists available at ScienceDirect
Journal of the American Pharmacists Association journal homepage: www.japha.org
SCIENCE UPDATES
Pharmacists make oncology and transplant patients happier? Patrick G. Clay
With additional scrutiny being paid to patient and provider satisfaction, hospital readmission rates, and medication costs, institutions may take comfort in knowing that recent publications reinforce the contributions pharmacists bring to these special populations. A comprehensive approach assessed the effects pharmacists were having on bone marrow transplant teams.1 Using a comprehensive analyses, the researchers segregated the project into 3 stages, with the first being clinical intervention, the second being economic, and the third being humanistic. Direct patient care activities included comprehensive discharge counseling to include coordination of insurance and prescription transfer, completing prior authorizations, and educating patients on the service. The authors do a nice job describing how these activities provided enhanced revenue streams (Phase 1) and economic benefit realizations (Phase 2) for both institution and patients, but the focus here is on the humanistic satisfaction aspect, as this is often a shortcoming of pharmacy service model publications. Across the 10 areas surveyed, despite high levels of patient satisfaction to start, pharmacists maintained or improved in all areas. Notably, in the provider satisfaction survey, pharmacists were distinctly more favorably perceived as compared with nurses (P ¼ 0.01) with a substantial increase in educating patients regarding transplantation revealing the greatest increase (62%e80%).
In a retrospective analysis conducted in a transplant unit offering pharmacist services including medication knowledge, adherence, and reconciliation at discharge and first follow-up visit, patients were statistically more likely to be readmitted within 30 days if they demonstrated medication nonunderstanding and nonadherence.2 These patients were shown to have a 2.3-fold higher rate comparatively across the entire cohort. This rate increased even more if the patient also had undergone dialysis (2.5) or had diabetes (2.9). This delineation of the greatest risk for readmission represents an opportunity for pharmacists engaging with transplant teams to focus on a subpopulation in whom services could be provided. A prospective, observational, pilot justification for services project using an oncology pharmacy resident in an outpatient oncology infusion clinic was conducted over just a 4-week period.3 A cost-avoidance approach and a projected impact of interventions made resulted in an economic impact of $138,441, or a benefit-cost ratio of 11.89:1. Although the figures are impressive, these are only projections; thus, it was the degree of satisfaction primarily worth noting here.
Each question responded to in the survey revealed 100% satisfaction with having a pharmacist present during infusion clinicdfor providers, nurse, and patients alike. Pharmacists continue to demonstrate quality services in a multitude of practice areas and disease states. The importance of validly capturing patient and provider satisfaction (humanistic outcomes) in addition to clinical and economic measures are encouraged to remain a constant presence in all future engagement reports. References 1. Alexander MD, Roa KV, Khan TS, Deal AM. Pharmacists’ impact on hematopoietic stem-cell transplantation: economic and humanistic outcomes. J Oncol Pract. 2016;12:1e11. 2. Covert KL, Fleming JN, Staino C, et al. Predicting and preventing readmissions in kidney transplant patients. Clin Transplant. 2016;30: 779e786. 3. Randolph LA, Walker CK, Nguyen AT, Zachariah SR. Impact of pharmacist interventions on cost avoidance in an ambulatory cancer center. J Oncol Pharm Pract. 2016 [Epub ahead of print]. Patrick G. Clay, PharmD, AAHIVP, CPI, FCCP, APhA Science Officer and Professor of Pharmacotherapy, College of Pharmacy, University of North Texas System, Fort Worth, TX
The Science Updates column highlights research published in journals other than JAPhA that is of interest to the Journal's readership. APhA members who have published research are encouraged to forward the PubMed citation, or an electronic version of their article, as soon as they appear or ahead of print, to Contributing Editor Patrick G. Clay, PharmD, AAHIVP, CPI, FCCP at [email protected].
http://dx.doi.org/10.1016/j.japh.2016.10.001 1544-3191/© 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.
Contents lists available at ScienceDirect
Journal of the American Pharmacists Association journal homepage: www.japha.org
SCIENCE UPDATES
Pharmacists make oncology and transplant patients happier? Patrick G. Clay
With additional scrutiny being paid to patient and provider satisfaction, hospital readmission rates, and medication costs, institutions may take comfort in knowing that recent publications reinforce the contributions pharmacists bring to these special populations. A comprehensive approach assessed the effects pharmacists were having on bone marrow transplant teams.1 Using a comprehensive analyses, the researchers segregated the project into 3 stages, with the first being clinical intervention, the second being economic, and the third being humanistic. Direct patient care activities included comprehensive discharge counseling to include coordination of insurance and prescription transfer, completing prior authorizations, and educating patients on the service. The authors do a nice job describing how these activities provided enhanced revenue streams (Phase 1) and economic benefit realizations (Phase 2) for both institution and patients, but the focus here is on the humanistic satisfaction aspect, as this is often a shortcoming of pharmacy service model publications. Across the 10 areas surveyed, despite high levels of patient satisfaction to start, pharmacists maintained or improved in all areas. Notably, in the provider satisfaction survey, pharmacists were distinctly more favorably perceived as compared with nurses (P ¼ 0.01) with a substantial increase in educating patients regarding transplantation revealing the greatest increase (62%e80%).
In a retrospective analysis conducted in a transplant unit offering pharmacist services including medication knowledge, adherence, and reconciliation at discharge and first follow-up visit, patients were statistically more likely to be readmitted within 30 days if they demonstrated medication nonunderstanding and nonadherence.2 These patients were shown to have a 2.3-fold higher rate comparatively across the entire cohort. This rate increased even more if the patient also had undergone dialysis (2.5) or had diabetes (2.9). This delineation of the greatest risk for readmission represents an opportunity for pharmacists engaging with transplant teams to focus on a subpopulation in whom services could be provided. A prospective, observational, pilot justification for services project using an oncology pharmacy resident in an outpatient oncology infusion clinic was conducted over just a 4-week period.3 A cost-avoidance approach and a projected impact of interventions made resulted in an economic impact of $138,441, or a benefit-cost ratio of 11.89:1. Although the figures are impressive, these are only projections; thus, it was the degree of satisfaction primarily worth noting here.
Each question responded to in the survey revealed 100% satisfaction with having a pharmacist present during infusion clinicdfor providers, nurse, and patients alike. Pharmacists continue to demonstrate quality services in a multitude of practice areas and disease states. The importance of validly capturing patient and provider satisfaction (humanistic outcomes) in addition to clinical and economic measures are encouraged to remain a constant presence in all future engagement reports. References 1. Alexander MD, Roa KV, Khan TS, Deal AM. Pharmacists’ impact on hematopoietic stem-cell transplantation: economic and humanistic outcomes. J Oncol Pract. 2016;12:1e11. 2. Covert KL, Fleming JN, Staino C, et al. Predicting and preventing readmissions in kidney transplant patients. Clin Transplant. 2016;30: 779e786. 3. Randolph LA, Walker CK, Nguyen AT, Zachariah SR. Impact of pharmacist interventions on cost avoidance in an ambulatory cancer center. J Oncol Pharm Pract. 2016 [Epub ahead of print]. Patrick G. Clay, PharmD, AAHIVP, CPI, FCCP, APhA Science Officer and Professor of Pharmacotherapy, College of Pharmacy, University of North Texas System, Fort Worth, TX
The Science Updates column highlights research published in journals other than JAPhA that is of interest to the Journal's readership. APhA members who have published research are encouraged to forward the PubMed citation, or an electronic version of their article, as soon as they appear or ahead of print, to Contributing Editor Patrick G. Clay, PharmD, AAHIVP, CPI, FCCP at [email protected].
http://dx.doi.org/10.1016/j.japh.2016.10.001 1544-3191/© 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.