Background: Patient satisfaction with outpatient pharmacy services at our institution was below the target level, due mainly to long waiting times. A lean management strategy to reduce patient waiting time and increase the satisfaction of both patients and staff was developed and implemented. Methods: The project was conducted in the outpatient pharmacy of a comprehensive cancer center in Amman, Jordan. The process started with formation of a multidisciplinary team and A3 problem-solving, which is a 10-step scientific method with measurable patient-centered outcomes. Average patient waiting time and level of patient satisfaction were compared before and after full implementation of the process. In addition, a survey was conducted among the pharmacy staff who worked in the outpatient pharmacy during the process to determine its impact on staff satisfaction. Results: Patient waiting time for prescriptions of fewer than 3 medications and of 3 medications or more decreased significantly (22.3 minutes vs 8.1 minutes, P < .001, and 31.8 minutes vs 16.1 minutes, P < .002, respectively), and patient satisfaction increased (62% vs 69%; P = .005) after full implementation of the project. The majority of the pharmacy staff reported that the process motivated them in their work and that both their jobs and their relationships with their managers and colleagues had improved. Conclusion: Application of lean management in an outpatient pharmacy was effective in reducing patient waiting time and improving the satisfaction of both patients and employees.

Background Mail-order services for refilling prescriptions for medications have been established in many countries and have increased patient satisfaction. We developed a mail-order service for the outpatient pharmacy of a comprehensive cancer center in Jordan. Objective To describe the implementation of a mail-order service and to report the impact of the service on patient satisfaction and the pharmacy workload. Methods A multidisciplinary team was formed to plan a mail-order service for refilling prescriptions for medications, and a survey was designed to evaluate patient satisfaction with the service. Patients were instructed to call the refill call center and order their medications at least 48 hours before their refill is due. The pharmacy workflow for refilling prescriptions was evaluated, and the time required with and without the mail-order service was documented, with a calculation of the time saved. Results At 1 year after the mail-order service had been established, 14 200 prescriptions had been refilled through the service, with the majority (97.5%) dispensed within 48 hours of the order time. As per the survey conducted with 219 patients, on the overall satisfaction, 69.4% reported being highly satisfied with the service and 27.9% reported being satisfied. The problems reported with the service were delay in arrival (n = 23, 10.5%), medication-related errors (n = 9, 4.1%), cash-related error (n = 1, 0.45%), improper storage condition (n = 1, 0.45%), and delivery to the wrong address (n = 4, 1.8%). The service was also associated with reduced overall time for processing in the outpatient pharmacy service; for patients receiving their medications from the pharmacy, resulting in reduced patients’ overall waiting time (from 11.4 to 8.2 minutes). The service resulted in saving of 0.4 full-time employee at 1 year of implementation. Conclusions A mail-order service for refilling prescriptions within a hospital setting had positive outcomes on both patient satisfaction and the pharmacy workflow. The major issues were related to transportation and logistics.

products and its impact on access. METHODS: Volume, type and timelines of evidence generation was identified and compared between the four products. The scope of evidence includes early access programs (EAPs), expanded access programs, pivotal trial extension studies, and real world evidence. Time to positive health technology assessment (HTA) outcome was assessed in 4 major European markets. RESULTS: All products received CMA based on ongoing phase II or I/II trials and required phase III data for full MA, which were ongoing when CMA was granted. Official EAPs were initiated in Europe for all products. In addition, expanded access program(s) were conducted for other geographies. Open-label extension studies collecting long-term data was identified for all products except osimertinib where an extension study was not initiated yet as the phase III is still ongoing. A range of observational studies and registries have been initiated for all 4 products to collect efficacy and safety data, as well as patient reported outcomes (PRO), pharmacoeconomics and data on real world clinical practice such as biomarker testing and treatment patterns. Time from CMA submission to first positive (with restrictions) HTA outcome was faster for all products versus standard MA benchmark (26.8 months), with osimertinib being quickest (15.8 months) and alectinib slowest (25.7 months). CONCLUSIONS: These 4 case studies showed that in diseases with high unmet need, companies are using a full range of evidence generation opportunities to complement the main clinical trials. This additional commitment to a broader and earlier understanding of the product may have a positive impact on the market access outcome.

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Background Despite the demonstrated efficacy and safety of biosimilar filgrastim-aafi (Nivestim™), few studies have compared its use in real-life clinical practice to the originator filgrastim (Neupogen™). Objectives This study aimed to compare the effectiveness and safety of filgrastim and filgrastim-aafi for the primary prophylaxis of chemotherapy induced-febrile neutropenia in the real-life setting. Patients and methods A retrospective cohort study included all adult cancer patients at the King Hussein Cancer Centre requiring primary prophylaxis for chemotherapy-induced febrile neutropenia between 2014 and 2016. Two cohorts were selected: patients who received filgrastim and those who received filgrastim-aafi. The primary endpoint was the incidence of febrile neutropenia; the secondary endpoints were the incidence of adverse drug reactions (ADRs), hospital admissions due to febrile neutropenia, and the mean length of hospitalization. Chi-squared tests were performed to evaluate differences between groups. Logistic regression was conducted to adjust for confounding factors. Results A total of 268 patients were identified, with 88 in the filgrastim cohort and 180 in the filgrastim-aafi cohort; 64%were females. The mean age was 47 (±15) years. The incidence of febrile neutropenia was 21.6% in the filgrastim cohort and 15% in the filgrastim-aafi cohort (P = 0.179). No statistically significant differences were detected in the incidence of hospital admission (P = 0.551) or ADRs (P = 0.623) between the two cohorts. Upon adjusting for the confounding factors, results remained statistically insignificant. Conclusion Filgrastim and filgrastim-aafi had comparable effectiveness and safety as primary prophylaxis for chemotherapyinduced febrile neutropenia. More extensive prospective studies with additional insight on the cost implications are required.