Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Oral oncolytics come with significant concerns of noncompliance due to complex regimens, adverse effects, and high overall costs. The Geisinger Oral Chemotherapy Clinic is a fully telephone-based medication therapy disease management (MTDM) program designed to integrate pharmacists as advanced practitioners in hematology/oncology clinics for comanagement of oral chemotherapy. Summary To date, Geisinger has 11 oncology clinics and 3 full-time pharmacists designated to the management of oral chemotherapy. Pharmacists receive referrals for comanagement of patients starting oral oncolytics. Under a collaborative practice agreement, they can order laboratory tests as well as supportive care medications and refills. Pharmacists review planned therapies, perform medication reconciliations, and provide medication counseling. Once treatment has been initiated, pharmacists contact patients for laboratory and toxicity assessments. The clinic incorporates the use of customized smart data elements within the electronic medical record to collect data regarding pharmacist interventions and time allocations in the clinic. As of March 31, 2021, the clinic was actively following approximately 1,100 patients, resulting in an average of 80 to 90 encounters per day for new referrals, chemotherapy education, and laboratory and toxicity assessments. Approximately 2,113 patients were followed from December 1, 2019, to March 31, 2021, with 46,929 interventions documented. Conclusion By obtaining provider buy-in for pharmacy services, acquiring enough personnel resources to meet the needs of the growing patient population and respective therapies, and proper utilization of technology, the program has thrived, allowing for increased provider and patient satisfaction. Future goals include expanding collection of pharmacist intervention metrics and analysis of patient perceptions of services provided by the clinic.

Background: Cytoreduction utilizing hydroxyurea to achieve a hematocrit (HCT) <45% has improved clinical outcomes for patients with Polycythemia Vera (PV). Pharmacists, through a collaborative practice agreement with hematologists, are uniquely posited to act as physician extenders and therapeutically dose adjust hydroxyurea (HU). Since 2013, HU therapeutic drug monitoring for PV patients has been transitioned to pharmacists in our oral chemotherapy clinic. We conducted a retrospective cohort cross-over study to evaluate pharmacist versus physician HU management to achieve a therapeutic HCT <45%. Methods: We retrospectively queried our institutional electronic medical record to identify patients diagnosed with PV with a documented ambulatory HU prescription. Additionally, patients' HU must have been managed by a physician (Phys) and subsequently crossed over to a pharmacist (PharmD) with at least two documented encounters by each clinician type. Hematological parameters for therapeutic drug monitoring are outlined in Table 1. Descriptive statistics were used for demographic information and a random effects model was used to evaluate HU management between Phys and PharmD. We fit a generalized linear regression model with random intercepts for each patient, using SAS's PROC GLIMMIX and Laplace approximation method t-test for a significant difference in probability of a therapeutic measurement between PharmD and Phys managed patients. Odd ratios were also calculated and adjusted for age and sex. Statistical analysis was performed using SAS (SAS9.4 SAS Institute, Cary, NC) and R software (The R Group, Vienna, Austria), with p<0.05 considered statistically significant. Results: Between 1/1/2003 and 1/20/2020, 104 patients meet the inclusion criteria. This cohort was primarily female (53%), white (97%), and aged 71 years during PharmD management vs 69 years during Phys management. The median time of a patient's HU management by PharmD was 2.4 years (IQR 1.2-3.8), Phys was 0.7 years (IQR 0.02-4.2), and overall was 3.6 years (IQR 2-6.6). 3154 complete blood count measurements were collected in the PharmD cohort and 2007 were collected in the Phys cohort. HU management by PharmD vs Phys resulted in statistically significant increases of therapeutic HCT measurements (p<0.0001) and platelet (PLT) measurements (p<0.0001) as shown in Figure 1. These outcomes remained significant when adjusted for both age and sex: HCT 87.8% vs 74.7% (p<0.0001) and PLT 78.4% vs 70.1% (p=0.0001). There was no difference white blood cell (WBC) therapeutic measurements between cohorts nor when adjusted for age and sex. Patients in the PharmD cohort had higher odds of achieving therapeutic HCT (OR 2.44; 95% CI [1.92 - 3.10], p<0.0001) and PLT (OR 1.55; 95% CI [1.25 - 1.92], p=0.0001) goals (Table 1). In terms of hematological safety parameters, there was no significant difference in neutropenia (OR 1.30; CI 95% [0.51-3.25]) with PharmD vs Phys HU management. All grade neutropenia occurred in 35 (1.1%) and 18 (0.9%) of patients between the PharmD vs Phys cohort, respectively. Grade 3 neutropenia occurred in 1.1% of patients in both cohorts with no instances of Grade 4 neutropenia. Conclusion: These findings support the efficacy of pharmacist therapeutic drug management of HU for patients with PV. Pharmacists managing HU achieve a target HCT and PLT count more often than physician management. By acting as a physician extender, pharmacist HU management for PV patients can help decrease the clinical burdens on physicians without compromising efficacy. Disclosures No relevant conflicts of interest to declare.

Hodgkin's lymphoma (HL) is a type of cancer originating in the lymph nodes. The preferred therapy for advanced HL is a combination of chemotherapies including doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD). ABVD has been standard therapy for advanced HL. It is generally considered as safe and rarely has been reported to cause acute liver failure. We present a case of 79-year-old woman with HL, who developed acute liver failure secondary to first cycle of ABVD chemotherapy.

Purpose To evaluate neuro-oncology clinician time utilization for medication management and identify a cost beneficial role for integration of a dedicated pharmacy specialists. Methods A pharmacist was temporarily integrated into a neuro-oncology clinic for a 30-day period to evaluate the clinical practice and perform a 14-day clinical chart evaluation and patient interactions as part of a single institutional exploratory analysis. The pharmacist completed screenings for drug-drug interactions, new therapies, medication reconciliation, and advanced interventions as part of a collaborative practice agreement for pharmacist autonomy. Pharmacist time spent was calculated and documented within the patient encounters to support physician decision-making. A comparative estimate of pharmacist versus physician time utilization and cost for each was completed to derive a savings analysis for integration of a dedicated clinic pharmacist. Result During the 14-day clinical assessment, the pharmacist completed 147 encounters with 338 interventions. Of the encounters, 90% (n = 132) were higher complexity requiring plan modification, and approximately 48% (n = 162) of all interventions required ≥10 minutes of the pharmacist’s time. Physician non-patient-facing time devoted to medication tasks was 5-hours weekly (0.125 FTE, full time equivalents), an estimated direct salary cost of $937/week ($45,000 yearly). Hire of a part-time pharmacist at 0.50 FTE would cover the clinical need with supported documentation and medication monitoring at a cost of $45,000/year. Conclusion Defining the roles for dedicated neuro-oncology clinic pharmacists allows for cost-savings through re-allocation of physician time and improves subspecialty clinic operations as well as patient care.

Introduction Geisinger in Danville, Pennsylvania, has pharmacist‐managed oral chemotherapy clinics that manage approximately 100 patients per day. Through a collaborative practice agreement with the provider, the pharmacist serves as a clinical extender to manage patients' oral oncolytics between provider visits. Previous studies have described the clinical and financial impact of a pharmacist‐driven oral chemotherapy clinic, yet there is a paucity of data regarding patients' perceptions of the care received in such clinics. Objectives We aimed to conduct a qualitative, semi‐structured, and descriptive study to better understand the patients' perceived role of the pharmacist in their care, perceived benefits, and opportunities for optimization. Methods Patients were prospectively sampled from clinic records in this single clinic study. Eligible patients must have a clinic visit between November 2020 and March 2021, be at least 18 years of age, and have at least six documented encounters with the clinic pharmacist within the last 6 months. Patients were excluded if they were residents of a nursing home or rehab if they required a professional caregiver, or if they had not personally talked with the pharmacist during at least four encounters within the previous 6 months. Results Out of 110 screened patients, 36 met the inclusion criteria, and 21 completed the interview. Overall, patients described the oral chemotherapy pharmacist as knowledgeable, helpful, and considerate of their situation. When comparing the oral chemotherapy pharmacist to a community pharmacist, some patients felt the oral chemotherapy pharmacist provided more personalized care. One area of improvement identified by patients included improving the clarity and consistency of clinic phone calls. Conclusions Based on the results of our thematic analysis, patients value the services provided in our pharmacist‐managed oral chemotherapy clinic; however, areas of improvement included how pharmacists communicate with patients regarding their care and the pharmacist's role within the care team.