Acceptability of pharmacist-led interventions to resolve drug-related problems in patients with chronic myeloid leukaemia

Abstract

Purpose Chronic myeloid leukaemia (CML) patients on long-term tyrosine kinase inhibitor (TKI) therapy are susceptible to drug-related problems (DRPs). This study aimed to evaluate the acceptability and outcomes of pharmacist-led interventions on DRPs encountered by CML patients. Methods This study included participants from the intervention arm of a randomised controlled trial which was conducted to evaluate the effects of pharmacist-led interventions on CML patients treated with TKIs. Participants were recruited and followed up in the haematology clinics of two hospitals in Malaysia from March 2017 to January 2019. A pharmacist identified DRPs and helped to resolve them. Patients were followed-up for six months, and their DRPs were assessed based on the Pharmaceutical Care Network Europe Classification for DRP v7.0. The identified DRPs, the pharmacist’s interventions, and the acceptance and outcomes of the interventions were recorded. A Poisson multivariable regression model was used to analyse factors associated with the number of identified DRPs per participant. Results A total of 198 DRPs were identified from 65 CML patients. The median number of DRPs per participants was 3 (interquartile range: 2, 4). Most participants (97%) had at least one DRP, which included adverse drug events (45.5%), treatment ineffectiveness (31.5%) and patients’ treatment concerns or dissatisfaction (23%). The 228 causes of DRPs identified comprised the following: lack of disease or treatment information, or outcome monitoring (47.8%), inappropriate drug use processes (23.2%), inappropriate patient behaviour (19.9%), suboptimal drug selection (6.1%), suboptimal dose selection (2.6%) and logistic issues in dispensing (0.4%). The number of concomitant medications was significantly associated with the number of DRPs (adjusted Odds Ratio: 1.100; 95% CI: 1.005, 1.205; p = 0.040). Overall, 233 interventions were made. These included providing patient education on disease states or TKI-related side effects (75.1%) and recommending appropriate instructions for taking medications (7.7%). Of the 233 interventions, 94.4% were accepted and 83.7% were implemented by the prescriber or patient. A total of 154 DRPs (77.3%) were resolved. Conclusions The pharmacist-led interventions among CML patients managed to identify various DRPs, were well accepted by both TKI prescribers and patients, and had a high success rate of resolving the DRPs.

Medication Risks and Their Association with Patient-Reported Outcomes in Inpatients with Cancer

“…DRPs per patient ranged from 4.8 (first therapy cycle) to 6.9 (fifth therapy cycle) [ 19 ]. However, our findings correspond to the studies of Nightingale et al and Tan et al, with three DRPs per patient, and Edwards et al, showing 3.7 DRPs per patient [ 6 , 18 , 20 ]. Interestingly, patients with solid tumor diseases received more drugs per patient (12.8 vs. 9.7, respectively) but experienced fewer drug-related problems (3.2 vs. 5.3, respectively).…”

“…A DRP is defined as an event during pharmacotherapy which interferes with a desired health outcome [ 17 ]. The number of reported DRPs in cancer patients ranges between three and five per patient [ 6 , 18 , 19 , 20 ]. DRPs can lead to increased morbidity, unnecessary hospital admissions, and mortality [ 15 , 21 ].…”