Characterization of collaborative practice agreements held by hematopoietic stem cell transplant pharmacists

Abstract

Background Current workforce shortages within the hematopoietic stem cell transplant field necessitate capitalizing on the role of oncology-trained pharmacists. Working within an agreed-upon protocol, pharmacists are able to expand patient care delivery through optimal medication therapy management. Methods An electronic survey was developed by the Advocacy & Policy Working Committee of the American Society for Blood and Marrow Transplantation Pharmacy Special Interest Group and distributed to pharmacists involved in the care of hematopoietic stem cell transplant patients. The primary objective was to assess the current state of collaborative practice agreements in the hematopoietic stem cell transplant setting. Results Forty-eight responses representing 41 institutions were returned. Respondents were mostly female (67%) and practiced in the adult setting (83%). Reponses represented a range of practice experience in hematopoietic stem cell transplant with the majority of the hematopoietic stem cell transplant positions (83%) funded by the department of pharmacy at an academic medical center. Of the 48 responses, 22 (46%) respondents reported having collaborative practice agreements in place; 10 (21%) respondents did not currently have collaborative practice agreements, but were planning to implement them; and 16 (33%) respondents did not have collaborative practice agreements at their institution. Clinical activities performed under a collaborative practice agreement included medication selection and dosing modifications, therapeutic drug monitoring, supportive care management, and management of comorbid conditions and chronic diseases. The most commonly cited barrier to establishing collaborative practice agreements was the inability to secure reimbursement for services provided. No respondents reported a negative impact on job satisfaction. Conclusions The results of this survey provide the pharmacy community with a robust understanding of the current landscape of hematopoietic stem cell transplant pharmacy collaborative practice agreements.

Impact of clinical pharmacy in oncology and hematology centers: A systematic review

“…7,8 The main contributions of clinical pharmacists in assisting onco-hematological patients include: evaluating the medical prescription regarding quantity, quality, compatibility, stability and interactions; supportive care management, such as managing anti-infectious therapies; assistance in the transition of care; evaluation of patients regarding the toxicity of chemotherapies and treatment effectiveness, in addition to tracking iatrogenic effects; educating patients, caregivers, as well as health professionals and interns; monitor, evaluate and report results related to treatment to help improve clinical practice. 9–13 Such activities are essential to promote patient safety when using antineoplastic agents and to avoid unnecessary expenses with the use of ineffective drugs for the patient or hospitalizations caused by complications resulting from medication errors that could be avoided. 14–16…”

The Hematopoietic Cell Transplant Pharmacist: A Call to Action

“…Addressing this need, the American Society of Transplant and Cellular Therapy (ASTCT, formerly ASBMT) Pharmacy Special Interest Group (SIG) has provided the "Fundamentals of HCT Training Course" and the "Beyond Fundamentals" course [13]. Lastly, addressing the NMDP SCI's recommendation to encourage CPAs to allow pharmacists to function as extenders and relieve some of the medication specific workload off of physicians and APPs the ASTCT Pharmacy SIG published a survey on the use of CPAs in HCT [14], which is detailed in the section below.…”

“…In a recent survey of HCT pharmacists, 46% of respondents had an existing CPA while an addition 21% stated they were planning to implement CPA. Activities covered under CPAs varied among sites but often included changing or discontinuing medications, therapeutic drug monitoring, or dose modifications (e.g., renal dose adjustment), as well as managing supportive care, including pain management, and comorbid conditions/chronic disease states [14]. Given the increased utilization of CPAs but notable variation in delegated activities, further reports of effective CPA models and correlation with outcomes are needed to aid in incorporation of CPAs into more HCT centers.…”

“…CPAs can be limited by inability to obtain reimbursement for pharmacist services, lack of willing provider collaborator, lack of back-up coverage, individual state scope of practice rulings, burdensome regulation, etc. [14,22]. Therefore, other options have been explored and encouraged.…”

Educational needs of oncology pharmacists: A survey by the International Society of Oncology Pharmacy Practitioners

“…However, such advanced roles of oncology pharmacists are either evolving or yet to be established in most countries. 10–12…”