A Department of Pharmacy team at UNC Hospitals has been recognized by the American Society of Health-System Pharmacists for the fifth year in a row with a National Best Practices Award. The team was recognized for their implementation of an oral chemotherapy program.
A Department of Pharmacy team at UNC Hospitals has been recognized by the American Society of Health-System Pharmacists for the fifth year in a row with a National Best Practices Award.
The award recognizes outstanding practitioners who have implemented innovative systems and demonstrated best practices in health-system pharmacy. The UNC team was selected as one of six recipients in the country.
Because the medication management of patients with cancer is shifting away from infusion clinics to oral chemotherapy administered at home, the team built an integrated, closed-loop, pharmacy-led oral chemotherapy program. The project entailed building an off-site pharmacy to provide URAC-accredited specialty pharmacy services, as well as embedding specialized clinical pharmacists in the oncology clinics. The pharmacists worked directly with patients on education, adherence monitoring and adverse-effect management.
The award-winning team consisted of
- Benyam Muluneh, Pharm.D., adjunct assistant professor;
- Molly Schneider, Pharm.D., lead pharmacist of UNC Share Services Center Pharmacy;
- Aimee Faso, Pharm.D., adjunct assistant professor;
- John Valgus, Pharm.D., assistant professor of clinical education.
- Lindsey Amerine, Pharm.D., assistant professor of clinical education and assistant director of pharmacy at UNC Medical Center;
- Rowell Daniels, Pharm.D., executive associate dean of pharmacy for clinical practice, director of pharmacy at UNC Hospitals and associate professor of clinical education;
- Brett Crisp, Pharm.D., M.S., assistant professor of clinical education and clinical manager of the UNC Ambulatory Pharmacy Care Network; and
- Scott Savage, Pharm.D., assistant professor of clinical education and associate director of pharmacy at UNC Medical Center.
The study, entitled, “Impact of an Integrated, Closed-Loop, Pharmacy-Led Oral Chemotherapy Program on Clinical and Financial Outcomes,” included 107 patients with varying malignancies, and there were a total of 350 patient encounters with clinical pharmacists.
In a survey conducted before the study, 93 participants reported less-than-optimal adherence, Muluneh said. Thirty percent of patients said they forgot to take their medications at least sometimes, and 21 percent intentionally cut back because of side effects or experienced delays in refilling their medication.
After the program was implemented, 85 percent of patients in the clinic for breast and gastrointestinal cancers were adherent as were 93 percent of patients in the clinic for blood cancers.
After an average of nine months on therapy, the pharmacy-driven oral chemotherapy program led to a higher major molecular response rate (83 percent) in chronic myeloid leukemia patients, which is a gold standard associated with long-term survival in these patients, Muleneh said. The project’s MMR rates were superior to published clinical trials, which had average MMR rates of 40 percent and 60 percent with one-year and two-year follow up, respectively.
Muluneh said the team was thrilled to learn they had been recognized by the greater pharmaceutical community.
“We all knew what we were doing was unique and very innovative,” he said. “All of us believe, deep in our hearts, that we are doing our best for our patients in delivering this type of care.”
The project also had positive financial outcomes, as the clinic exceeded the $4 million in expected revenue. Muluneh said he hopes attention from the award will promote the project and help it continue to expand.
“This will hopefully allow us to collaborate with other institutions as well and further refine the process and potentially do a multicenter analysis of a similar project,” he said.
The team will be recognized and present their project at the Midyear Clinical Meeting in New Orleans.