The impact of a supplementary medication review and counselling service within the oncology outpatient setting

Abstract

The impact on the care of breast cancer patients, of a pharmacy technician-led medication review and counselling clinic, provided in an outpatient setting, was investigated using a controlled randomised study. Compared to the controls, clinic patients showed a significantly improved level of understanding of their chemotherapy support medication (95% CI for difference in mean knowledge rating scores ¼ 2.165 -2.826, Po0.001) and a significant reduction in the median number of support items required (two compared to five in the control, Po0.001). This resulted in a significant reduction in mean medication expenditure per patient (d26.70 vs d10.20, 95% CI for the mean difference in cost d6.72 -d26.26, Po0.001). The clinic was also associated with significant reductions in chemotherapy delays (Po0.001) and dose reductions due to side effects (P ¼ 0.003). Other benefits from the clinic were a reduction in pharmacy dispensing time and a highly significant reduction in pharmacy time spent resolving post-clinic prescription queries (Po0.001). Taking into account the initial technician training cost, the scheme represented an annual saving to the Trust of over d15 000. The clinic serves as a model for those wishing to improve outpatient services to breast cancer patients.

Chemotherapy outpatients’ unplanned presentations to hospital: a retrospective study

“…Chemotherapy outpatients and their carers are frequently managing the physical and psychological effects of chemotherapy at home whilst simultaneously 'coming to terms' with a cancer diagnosis [7,9]. Although effective management of chemotherapy side effects is linked to improved patient outcomes [10], research suggests that patients who are managing symptoms at home are at risk of being undertreated as they tend to be invisible to healthcare services [11,12].…”

“…Chemotherapy-induced nausea and vomiting can be significant problems, despite major improvements in their treatment [10,11]. Research suggests that delayed chemotherapy induced nausea and vomiting, which affect 50-74% of chemotherapy patients, continue to be significant problems that are underestimated and undertreated [9,[11][12][13].…”

Chemotherapy Order Entry by a Clinical Support Pharmacy Technician in an Outpatient Medical Day Unit

“…There was a significant increase in patients' knowledge of their medications in the technician group, and a decrease in chemotherapy delays, chemotherapy dose reductions, number of support medications required, and drug costs. 16 However, the authors of that study did not examine chemotherapy order entry.…”

“…The 2 full-time technicians in their study screened about 400 patients per month and, in total, freed up more than 8 hours per day of pharmacist time to provide clinical activities. 15 In another study, Read and others 16 reviewed the ability of a pharmacy technician to provide medication reviews and patient counselling in an outpatient breast cancer clinic. The technician completed specialized training in medicines management, chemotherapy support medication, and patient counselling.…”

Role of pharmacists in optimizing the use of anticancer drugs in the clinical setting

“…112 The link between thrombosis and malignancy is well documented in cancer patients who have concomitant venous thromboembolism, having increased mortality over noncancer patients. 113 Cancer patients also experience increased complications and recurrence with chronic anticoagulation with warfarin. 114 The use of chemotherapy is a known risk factor for the development of venous thromboembolism.…”