New Orleans—To promote the safe use of oral chemotherapeutic agents being increasingly used in place of IV medications, hospitals may want to consider setting up an outpatient dispensing pharmacy within their oncology clinics.

That strategy has significantly boosted patient compliance, access to financial aid and several other factors that can have a direct impact on quality of care, according to Kathryn Schiavo, PharmD, clinical pharmacist and a member of the multidisciplinary oncology team staffing the onsite pharmacy at NorthShore University HealthSystem Kellogg Cancer Center in Evanston, Ill.

“Many oral chemotherapy agents are not stocked or carried by retail pharmacies and if they are stocked, the pharmacists there do not have the education about or the understanding of these drugs and can’t educate patients about their use,” Dr. Schiavo said at the sixth annual meeting of the Hematology/Oncology Pharmacy Association. The onsite outpatient pharmacy helps ensure that patients get the right drugs and instructions on how to use them, Dr. Schiavo told Pharmacy Practice News.

“We’ve also found that when patients are taking chemotherapeutic agents at home, their adherence rates are not as good as we would like them to be,” noted Dr. Schiavo. “So we’ve opened this pharmacy to help improve adherence and access to the drugs.” Additionally, Dr. Schiavo and her colleagues wanted “to increase patient medication counseling rates and improve access to financial assistance programs for patients in need.”

The Kellogg Cancer Center Point of Care Pharmacy opened in August 2009. Before it opened, Dr. Schiavo and her team surveyed 45 patients to gauge their access to and understanding of chemotherapy agents and to determine their overall satisfaction with their current dispensing pharmacy. Six months after the opening of the pharmacy, the researchers did a follow-up survey of 32 patients to discover how they felt about the new facility.

Before the pharmacy opened, 74% of the Kellogg Cancer Center patients were using a retail or chain pharmacy outside of the hospital location, 14% were using the NorthShore Hospital outpatient pharmacy, 10% were using a mail-order pharmacy and 2% were using other sources to obtain their drugs. More than one-third of the patients (37%) reported that they were not counseled about their medications at their current pharmacy, and of those who were counseled, only 15% were contacted for follow-up related to medication counseling questions. Of those who had difficulty paying for their prescriptions, 33% were offered financial assistance options. Respondents’ average patient satisfaction scores were 3.8, based on a 5-point scale.

Most of the patients (82%) were interested in using a pharmacy at the Kellogg Cancer Center that specialized in oral chemotherapy as well as symptom management. “The patients really liked the idea of having a place they could go to for their medications, and also being able to talk to a knowledgeable pharmacist in case they had questions or ran into problems,” said Dr. Schiavo.

The survey results after the point-of-care pharmacy was opened showed that 97% of respondents stated they received patient counseling for their medications at the pharmacy. Additionally, 78% of patients who had difficulty paying for their prescriptions were offered some form of financial assistance options.

“We really focused on access to the drug, getting the patient the medication, making sure they can fill the prescription. A big part of that was patient assistance,” Dr. Schiavo explained. “Unfortunately, a lot of these drugs are very expensive. In some cases, they are actually more expensive than the IV components. Insurance is a hard thing to navigate for some patients, especially when they are trying to deal with their illness, so we help them navigate the financial minefield. We have a financial advocate onsite who has an oncology pharmacy background and who advises patients who are having payment issues.”

The average patient score for pharmacy staff’s level of helpfulness and courtesy during their visit to the new pharmacy was 4.9 on a 5-point scale, and 100% of patients who completed the survey agreed that they had a professional interaction with the pharmacist and staff. All patients said they would recommend the new pharmacy to a friend.

More Work Needed On Reimbursement

Dr. Schiavo said she is now exploring ways to obtain reimbursement for the consultation that the new point-of-care pharmacy provides. “We do intensive counseling the first time patients get a prescription for any new oral chemotherapeutic agent; we go through side-effect monitoring; we do follow-up a week after they start their oral [chemotherapy] to assess adherence and make sure they are taking it correctly. Definitely, reimbursement is a big issue and one that we are looking into right now.”

The increasing number of oral chemotherapy agents, with still more in the pipeline, makes patient adherence an imperative, Ernest R. Anderson Jr., MS, RPh, FASHP, system vice president of pharmacy at Caritas Christi Health Care, in Brighton, Mass., told Pharmacy Practice News. “It takes a specialized level of knowledge to counsel patients on oral chemotherapy, and this is not something that most retail pharmacies are prepared to do, so education of patients at a cancer center pharmacy at the time of dispensing by the pharmacist makes lots of sense,” he said.

Finally, a dispensing pharmacy in an ambulatory cancer center represents a win–win situation for all stakeholders, but particularly for patients, according to Mr. Anderson. “Having a pharmacist at the cancer center who can look at all the options and who understands the entire chemotherapy regimen, including perhaps some IV chemotherapy in addition to the oral chemotherapy, is in the patient’s best interest,” he said. “That pharmacist sees the entire patient care plan and can help address each aspect with the patient.”