Recipients of the Certificate of Recognition for Exemplary Research on Quality of Care in Oncology

Sol Atienza, PharmD, BCOP
Clinical Oncology Pharmacy Specialist
Advocate Aurora Health
Aurora St. Luke’s Medical Center
Milwaukee, WI

Michael Manlick, PharmD
Clinical Oncology Pharmacist
Advocate Aurora Health
Aurora St. Luke’s Medical Center
Milwaukee, WI

The Quality Oversight Committee of the Hematology/Oncology Pharmacy Association (HOPA) congratulate the recipients of the Certificate of Recognition for Exemplary Research on Quality of Care in Oncology. Although not everyone can be a recipient of the award, there is sincere gratitude to all who do research and, as a result, improve the care of our oncology patients. The submissions that were received underwent a review process for their respective categories. Each abstract was evaluated and scored based on set criteria specific to the care of patients with cancer. Quality, value metrics, and the potential impact on the current practice in oncology were all taken into consideration.

At the HOPA 2022 annual conference in Boston, MA, there were five certificate recipients of the abstracts submitted. The completed research certificate was received by Jodi Taraba, PharmD (Mayo Clinic and The University of Kansas Health System); and four trainee research certificates were awarded to Sara Bugamelli, PharmD (Henry Ford Hospital), Arielle Davidson, PharmD candidate 2024 (University of Michigan College of Pharmacy, Michigan Oncology Quality Consortium, and Michigan Institute for Care Management and Transformation), Sara Nowak, PharmD (St. Luke’s Hospital and University of Minnesota, Duluth College of Pharmacy), and Anastassia Blewett, PharmD (University of Virginia Health).

Development and Implementation of a Pharmacist-Led Virtual Clinic Improves Management of Metastatic Breast Cancer Patients on CDK 4/6 Inhibitors, presented by Jodi Taraba, PharmD
Managing patient care remotely, using a patient-centered model, can be a challenging practice. Taraba and colleagues developed a pharmacist-led multidisciplinary virtual clinic to improve the care of patients on cycle dependent kinase (CDK) 4/6 inhibitors. There is increasing use of CDK 4/6 inhibitors in combination with endocrine therapy for patients with advanced hormone receptor positive (HR+), human epidermal growth factor 2 (HER2) negative breast cancer. Patients receiving palbociclib, abemaciclib or ribociclib were managed by the virtual clinic. They were primarily contacted by phone every 2 weeks for the first two months and then monthly thereafter. These visits included review of lab results, toxicity assessment, medication adherence, medication reconciliation and screening for drug interactions. Laboratory adherence was compared against a retrospective cohort of patients initiated on palbociclib. Labs were appropriately drawn at 462/541 time points in the retrospective cohort (n=81) and at 128/139 time points in the prospective cohort (n=28), (85.4% vs 92.1%, p=0.038). Medication adherence to the prescribed medication was reported at > 99%. Interventions included patient education on administration of therapy thereby increasing adherence, symptom management, drug/supplement interactions and QT prolongation monitoring. There were also 38 potential drug-related issues identified. Improved care in patients receiving CDK 4/6 inhibitor therapy was demonstrated in this pharmacist-led clinic through improved laboratory adherence. With sustainment of this practice model, expansion to other oral therapies is being considered.

There are also future plans to develop and implement interactive care by utilizing technology to manage patients on CDK 4/6 inhibitors.

Evaluating the Impact of Prior Authorization on Oncology Patients Admitted to the Hospital, presented by Sara Bugamelli, PharmD
With increasing costs in cancer care, insurers have implemented requirements such as prior authorization (PA). Obtaining a PA can be a time intensive and complex process that can lead to treatment delays. Pharmacy involvement has been shown to decrease processing time, increase approval rates, and decrease incident of delayed discharges due to the PA process. Adding to the complexity with a PA-required medication, there is also the transition from the inpatient to outpatient setting. Objectives of this study were to identify predictive factors that identify the need for PA, to determine the impact of PA on inpatient length of stay, and to describe the process for assessing medication access prior to hospital discharge. Inpatient and outpatient pharmacy services collaborated to implement a standardized electronic test claim or Discharge Medication Cost Inquiry (DMCI) process to determine out-of-pocket cost of medications and the need for PA prior to hospital discharge. Bugamelli and colleagues conducted an IRB approved retrospective, comparative cohort study of patients admitted to the inpatient oncology unit between January 2019 and December 2020. Inclusion criteria were ≥ 18 years of age, admitted to the inpatient oncology unit for ≥ 72 hours, and had a documented DMCI for filgrastim, tbo-filgrastim, filgrastim-sndz, and/or filgrastim-aafi. Exclusion criteria were the vulnerable populations, patients enrolled in hospice or comfort care, those admitted with a diagnosis of acute myeloid leukemia, and patients admitted for stem cell transplant (SCT) or who have previously undergone SCT. The primary endpoint of the study was total length of hospital stay in days. Secondary endpoints include incidence of PA approval or denial, time to PA approval or denial in days, and delay in discharge defined as necessitating further overnight hospitalization once medically stable for discharge. Data collection included patient demographics, insurance type, reason for admission, biosimilar in DMCI documentation, and outcome of PA. Study results have shown (1) no significant difference in patient characteristics to anticipate the need for PA, (2) no significant difference in total hospital length of stay or delay in discharge in patients requiring a PA for GCSF, and (3) effective and efficient securing of PA’s by inpatient pharmacists prior to discharge through the DMCI process.

Standardized Outcome Measurement for Embedded Clinical Oncology Pharmacy Services, presented by Arielle Davidson, PharmD Candidate 2024
Oncology pharmacists continue to develop the role to strive to provide high-value and high-quality care to our cancer patients. Justifying the benefits of the oncology pharmacists remains difficult despite the many benefits that have been described in the literature. The roles of oncology pharmacists continue to evolve with increased integration into direct patient care and greater management of cancer therapy side effects and adherence. The main objective was to describe a model, Pharmacists Optimizing Oncology Care Excellence in Michigan (POEM), that supports the integration of clinical oncology pharmacists based in community practices while providing a standardized outcome assessment of practices to justify the pharmacist role. A database was developed to generate quarterly standardized reports. Patient surveys were also implemented to assess patient satisfaction. As of December 2021, POEM had 6 clinical oncology pharmacists representing 24 oncology clinics. To date, 1,424 patients had been seen via 2,893 encounters, which resulted in 3,065 pharmacist interventions. Demographics included a population that was 93% white, 5% black, 50% male, and 73% age equal to or greater than age 60. The primary reasons for pharmacist care were treatment with oral anticancer agents (OAA) (52%), non-immunotherapy IV (22%), immunotherapy (20%), and other (7%). A care management code was used to bill 66% of encounters. Types of interventions were education and referrals (52%), medication modification (24%), and comprehensive medication review or medication reconciliation (21%). Survey showed that patients felt it was important to meet with a pharmacist prior to beginning their cancer treatment. With success of justifying the beneficial role of the oncology pharmacist, this study supported expansion of the POEM program to 12 additional pharmacists to sites in 2022-2023. Future plans include analysis of pre- and post-data of healthcare utilization and patient risk.

The Impact of Patient and Provider Education on Colorectal Cancer Screening Rates at a Rural Clinic: A Quality Improvement Study, presented by Sara Nowak, PharmD
Guidelines for colorectal screening have recently been updated to help further identify the third most common cancer in the United States in men and women and leading cause of cancer-related death. Due to the growing incidence of colorectal cancer in younger patients, in 2021, the United States Preventative Services Task Force (USPSTF) expanded their screening recommendation to include patients aged 45-49 compared to their previous recommendation of beginning screening at the age of 50. Regular screening improves patient outcomes and reduces mortality. An initiative to achieve a screening rate of 80% in every community in the United States was established by the National Colorectal Cancer Roundtable. Pharmacists are well positioned to promote colorectal cancer screening through educational interventions. Nowak and colleagues conducted this quality improvement study to evaluate the impact of colorectal cancer screening rates through pharmacist provided education to patients and providers. The primary objective of the study was to assess post-intervention screening rates among previously unscreened adult patients aged 45 to 49 who receive care at a rural clinic. Secondary objectives include an assessment of the frequency of each type of screening (i.e., colonoscopy, stool tests, etc.), the number of abnormal findings through screening, the number of patients contacted who report they were already screened but were not identified in a generated report, and the perceived benefit of the provider education via a survey. The baseline screening rate was also determined. During the intervention period, patients were contacted via a mailed letter and scripted phone calls with education on colorectal cancer screening. Following the interventions, a chart review was conducted to determine the proportion of patients who have scheduled and completed colorectal cancer screening within a 3-month period. This study remains ongoing as patient interventions are further implemented; however, all providers felt that the live education increased their knowledge on colorectal screening. If further successful results, future plans are to expand to additional populations in the region.

Utilization of UVA Health Pharmacies for Outpatient Prescription Dispensation in the Malignant Hematology & Thoracic Oncology Clinics, presented by Anastassia Blewett, PharmD
An increase in prescription capture rates can lead to improved transitions of care, better medication adherence, and increased revenue for the organization. This retrospective chart review evaluated patients receiving prescriptions from the thoracic and malignant hematology clinics. The focus of the project was to implement interventions to improve prescription capture in their pharmacies and to determine how to assess and improve capture rates from outpatient oncology clinics. A multidisciplinary team evaluated the cancer center workflow and prescription filling process using a process mapping and fishbone diagram methodology. Between July 2020 to June 2021, the capture rate of the top oral non-chemotherapy prescriptions was 82.8%. The capture rate for the top oral chemotherapy and targeted agents from 2016 to 2021 was 44%. Barriers to prescription capture included drug availability, patient factors, pharmacy hours, staffing shortages, and lack of pharmacy advertisement. A Pareto chart illustrated the reasons for prescriptions not being filled. The most common reason being free drug, a close second reason was identified as contracts to outside specialty pharmacies, and the third reason was declining of treatment or transitioning to hospice. Future direction includes development of standardized reports to track prescription capture, discussing opportunities to negotiate insurance contracts, obtaining more resources to utilize pharmacy technicians, and advocate for increased staffing in the pharmacies to decrease dispensing delays and support medication delivery to patients.

Congratulations again to our award winners, and to everyone who presented their research at HOPA in 2022. All your hard work has not gone unnoticed and will bring change to our profession and, more importantly, improve patient care in the field of oncology.