Expansion of pharmacist practice in oral oncolytic therapy with a collaborative practice agreement

Abstract

Introduction: Collaborative practice agreements have been utilized to expand pharmacist roles and improve patient care outcomes. A need to reduce the time providers spend reviewing oral oncolytic prescriptions for therapy continuation or dose adjustments was identified in the oncology clinics of a community health system. A collaborative practice agreement was created to decrease turnaround time for processing oral oncolytic prescriptions, improve provider satisfaction, and decrease patient prescription costs. Methods: A three-month pilot was initiated to evaluate feasibility and provider satisfaction by comparing two provider groups. An additional three months of data were collected post-collaborative practice agreement implementation to evaluate impact. Primary endpoints included: interventions, turnaround time, and patient cost savings. A survey was conducted to determine provider satisfaction. Results: The mean turnaround time for pharmacist interventions in the pilot group (n ¼ 54) was 7 min, compared to 3311 min in the control group (n ¼ 87), which was statistically significant (p < 0.0001). Two interventions in the pilot group resulted in patient cost savings due to dose rounding by a pharmacist. The mean turnaround time of the postcollaborative practice agreement group (n ¼ 197) was 6 min, which was statistically significant when compared to the control group (p < 0.0001). Conclusion: Turnaround time was significantly shorter for prescriptions in the pilot and post-collaborative practice agreement groups compared to the control group. Provider satisfaction increased as the collaborative practice agreement resulted in less time reviewing oral oncolytic prescriptions. Patient costs were also reduced during the pilot phase due to dose rounding by pharmacists.

“The Impact of Pharmacists Engaged in Collaborative Practice Agreements in the United States”

“…8 CPAs were already in place in 7 of the 8 studies, and the goals or the interventions in those studies were to assess the CPAs and to determine whether there was a need for changing the CPAs. [3][4][5][6][8][9][10] CPA protocols were understandably diverse due to the differences in the study settings and patient populations. Studies that were conducted in larger settings, such as a large academic institution, 3 an urban health center, 4 or more than 1 clinic, 9 allowed for more pharmacist engagement in their CPA protocols.…”

“…[3][4][5][6][8][9][10] CPA protocols were understandably diverse due to the differences in the study settings and patient populations. Studies that were conducted in larger settings, such as a large academic institution, 3 an urban health center, 4 or more than 1 clinic, 9 allowed for more pharmacist engagement in their CPA protocols. 3,4,9 For example, more pharmacistsand even pharmacy residents and APPE students 4 were allowed to participate.…”

“…Studies were published in English across various states in the United States, such as Maryland, 3 Wisconsin, 4 Indiana, 5 California, 6 Minnesota, 7 and Michigan. 8 Study types were an interventional study, 3 a retrospective chart review and survey, 4 an institutional review board – approved retrospective analysis, 5 a descriptive study, 6 a pilot study, 9 a multi-center cross-sectional survey, 10 an uncontrolled quasi-experimental study, 7 and a retrospective quasi-experimental study. 8 Studies were conducted on solid organ transplant recipients at a large academic medical center 3 ; underserved patients with type 2 diabetes mellitus at an urban, underserved federally qualified health center 4 ; patients populating the emergency department at a community hospital with positive culture results requiring antimicrobial treatment 5 ; inmates on warfarin treatment at an anticoagulation clinic that was initiated in the Los Angeles County jail 6 ; patients with breast, prostate, lung, colon/rectal, non-Hodgkin lymphoma, and hematologic cancers at 5 ambulatory oncology clinics 9 ; hematopoietic stem cell transplant patients at 41 hematopoietic stem cell transplant institutions 10 ; patients prescribed antipsychotic medications at a large academic medical center for inpatient psychiatric patients 7 ; and urgent care (UC) patients with positive urine or wound cultures following discharge at 2 free-standing UC sites participating in an antimicrobial stewardship program.…”

“…Studies that were conducted in larger settings, such as a large academic institution, 3 an urban health center, 4 or more than 1 clinic, 9 allowed for more pharmacist engagement in their CPA protocols. 3,4,9 For example, more pharmacists – and even pharmacy residents and APPE students 4 – were allowed to participate. 3,4,9 Pharmacists were also assigned a broader range of tasks, such as medication regimen or dose adjustment, prescribing and dispensing medications, ordering laboratory tests, and so on, and they were allowed to perform these tasks more independently.…”

“…The studies analyzed share a common theme of positive pharmacist impact when engaged in CPAs as demonstrated by the achievement of the desired clinical goals, [3][4][5][6][7][8][9] attainment of financial benefits, 3,9 and overall constructive contributions to the healthcare system. Pharmacist engagement in CPAs proved valuable in numerous settings and among a variety of patient populations, which goes to show that, even in nontraditional settings, there is a need for establishment of CPAs that allow pharmacists to expand their scope of practice and work alongside physicians and other healthcare providers.…”