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NCODA Spring Forum 2018

Dr Ali McBride: Addressing Adherence Issues With Patient Education

Patient education is critical for improving adherence as many patients don’t always know what their medications are or even how they can be taken with other medications they area already on, said Ali McBride, PharmD, MS, BCPS, clinical coordinator for University of Arizona Cancer Center.


Patient education is critical for improving adherence as many patients don’t always know what their medications are or even how they can be taken with other medications they area already on, said Ali McBride, PharmD, MS, BCPS, clinical coordinator for University of Arizona Cancer Center.

Transcript

What are some strategies you use to help improve adherence to oral oncolytics?

We actually work with our pharmacists and our clinical pharmacists are in clinic at my site. And what they do is they work with our nurses, our nurse practitioners, advanced practitioners, and also our physicians doing telephone discharge phone call follow-ups for newly diagnosed patients coming out of the hospital addressing: did they get their medication? Are they on the right medications? Do they even know how to take the medications? This pilot program, which is now expanding has really addressed the critical need for adherence issues.

One of the things that we’re finding out is even at the time of discharge, patients don’t know what their medications are. So, they’ve already been through a horrific event—they got diagnosed with cancer, sometimes in the inpatient setting—and now someone tells them to take a pill, but they’re on 10, 15 other supportive care pills as well. And when they get that prescription, sometimes they don’t have that prescription there for them, so by doing or enacting adherence phone call follow-ups, and discharge phone call follow-ups, we’ve actually been growing our patient understanding but also increasing patient adherence.

In addition, we also have data from our breast cancer area where we’ve also been doing adherence phone call follow-ups and actually monthly check-ups with our patients as well. Really adding to the education piece but looking forward to a lot of the new entities coming along with these oral therapies. I think the one thing right now where we’re seeing a change is the combination utilization of both intravenous or parenteral medication and the oral medication. This provides a very different discussion piece, because the patient is coming to the infusion center, getting their, for example, rituximab, and also receiving a prescription for an oral therapy, like ibrutinib, in this case for [chronic lymphocytic leukemia]. That combination is 2 different types of administrations.

So by working and looking at what happens with these patients we have to do a lot of education, address both components for how they’re taking medication, and also the side effect profiles for their patients while on therapy.

What are some of the challenges of the Oncology Care Model and what key learnings have you taken away so far?

We actually have a number of people on the OCM project, I’m just one in regards to that. This has been a long-standing project through OCM pilot development. One piece is, of course, looking at the education, another area which has been really discussed for many years on those 10 pieces is also looking at adherence and dose changes. We’re looking at side effect profiles, evaluating patients for the correct chemotherapy, making sure they’re being mitigated for their disease control, and also side effect management to ensure adherence. That’s one part of that puzzle as well.

There’s other areas, which are also being developed as part of our team in which looking at payments, evaluating the data and also addressing cost-based valuations for the total cost of care in these populations, as well. My part is just 1 small part of that looking at the old-world piece for OCM. But the oral piece on that is a big discussion as we see time go on for current chemotherapies and also sequencing of therapies down the line.

 
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