Practice Guidelines and the Decision-Making Process for MPNs

Michael Reff, RPh, MBA, and Kathy Oubre explain the internal guiding documents that aid a practice’s decision-making and workflow when treating patients with MPNs.

Bruce Feinberg, DO: Michael, when developing the programming concept, did it address the therapies from a standpoint of creating a guideline for the treatment, or was it an integrated, uniform approach to patient care when on a therapy but no guidance about stepping the therapy?

Michael Reff, RPh, MBA: We have about 55 positive quality interventions [PQIs], and they are documents that are written by clinical experts from around the country, and they are then peer reviewed. These documents are on our website, and when we went through for these particular MPN [myeloproliferative neoplasm]-type PQIs, we looked at individual aspects for not only the drug but also the disease states. We leaned on our clinical experts to identify where a medically integrated team would intervene for better outcomes for the patients. It is disease-dependent, and in some cases, it is product-dependent, where we have developed tools and education platforms to help the medically integrated team.

Whether it is the nurse, the advanced practice provider, the clinicians, or the medical oncologist, they all have a reference point to help them elevate their understanding of disease states and/or specific drugs. I will moderate here and turn the podium back over to Kathy where she can talk a bit more specifically about what was rolled out at her practice [at Pontchartrain Cancer Center].

Bruce Feinberg, DO: I would love to hear that Kathy, specifically in terms of how you saw or your clinicians saw this differently than the NCCN [National Comprehensive Cancer Network] did.

Kathy Oubre: I cannot speak to that, so my apologies. What I can tell you though is, this is the PV [polycythemia vera] workflow for our company. It talks from the beginning about ordering the laboratory tests, therapeutic phlebotomy; we talk about laboratory test levels and such here. Then for step 2, hydroxyurea; Jamile mentioned that earlier. It then talks about laboratory test draws after that and what that all looks like. Then there is step 3 and where we go from there.

Bruce Feinberg, DO: How programmatic are we talking? Is it literally week 1 then week 2, or is it general guidance?

Kathy Oubre: It is more like general guidance, but it has that decision tree with laboratory tests and therapeutic phlebotomy if needed. Then, if the hematocrit level is greater than this, we do this. If it is less than this, we do this. It has decision trees all the way down.

Michael Reff, RPh, MBA: One of the things that you and all practices need to understand when they are developing a quality initiative program and are utilizing a tool such as the PQI document itself, is that the benefit there is not just that initiation right around diagnosis; it is also follow-through and refills. Whether it is on Jakafi [ruxolitinib] or other products, it is taking that holistic, process-flow approach. What the positive quality intervention document does is it breaks it down step-wise like SOP [standard operating procedure] algorithms that may have been mentioned earlier. In a sense, it boils down some of the specifics so that all of the high points are not lost. It helps guide the team for better clinical decision-making.

Bruce Feinberg, DO: Was it designed to be shared with the patient or as an internal team document?

Michael Reff, RPh, MBA: It is mostly for an internal team. I have heard of an occasional practice in which a patient has an interest, and they will say, “This is one of the guiding documents that we are utilizing,” but it is not part of the teaching consent or the normal educational process.

Transcript edited for clarity.

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