Pharmacists Coordinated Care Oncology Model (PCOM) for Patients Taking Oral Anti-cancer Medications

University of Michigan Rogel Cancer Center6 enrolled

Overview

The objective of this study is to improve medication, symptom, and disease management of patients with hematological malignancies and multiple chronic conditions (2 or more conditions in addition to cancer) through care coordination between pharmacists working in oncology practices and those working in primary care practices (Pharmacists Coordinated care Oncology Model \[PCOM\]). This is a pilot study in which the investigators will examine the association between outcome measures, but the study design and sample size are insufficient to quantify the impact of OAA initiation or OAA adherence on adherence to chronic medications. This pilot study and data analyses are being done in preparation for a larger, controlled study.

Study Type

INTERVENTIONAL

Allocation

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Enrollment

Conditions

Chronic Myeloid Leukemia Chronic Lymphocytic Leukemia Multiple Chronic Conditions

Patient Reported Outcome Measure (PROM)OTHER

Participants will complete a PROM (Michigan Oncology Quality Consortium, Patient Assessment Tool for Oral Chemotherapy) for their oral anticancer agent (OAA) at two timepoints over 2 months, to assess patient symptoms and adherence to OAA.

Comprehensive Medication Review (CMR)OTHER

Following the first PROM, participants will be contacted by the primary care pharmacist for a Comprehensive Medication Review (CMR) for their chronic medications. If warranted, a follow-up CMR will take place after the second PROM.

Communications between oncology and primary care pharmacistsOTHER

Throughout the study, the oncology and primary care pharmacists will communicate about medications through the electronic medical record.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Has primary care physician * Diagnosis of chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL), chronic myeloid leukemia (CML), or multiple myeloma (MM) * Initiating an OAA, either for the first time or a change from previous OAA * Diagnosis of at least 2 chronic conditions, including at least one of the following: diabetes, hypertension, hyperlipidemia, congestive heart failure, depression/anxiety, gastroesophageal reflux disease, and/or chronic obstructive pulmonary disease * Patients taking at least two chronic medications, including at least one medication for one of the conditions listed above. * Willing and able to sign informed consent. Exclusion Criteria: * Cannot speak English * Concurrent diagnosis of type 1 diabetes * Concurrent diagnosis of human immunodeficiency virus

Outcomes

Primary Outcomes

Dose-adjusted proportion of days covered (PDC) for oral anti-cancer agent (OAA)

PDC is a common way to assess a patient's adherence to a medication regimen. PDC is the ratio of number of days the patient is supplied with OAA medication, from the time of OAA initiation until 6 months later, to the total number of days during that period. For OAAs, data from the electronic medical record (EMR) for dose changes will be aligned with the refill data to calculate a dose-adjusted PDC.

Time frame: Up to 6 months following OAA initiation

PDC for chronic condition medications

PDC is the ratio of the number of days the patient is supplied with chronic condition medications, from the time of OAA initiation until 6 months later, to the total number of days during that period.

Time frame: Up to 6 months following OAA initiation

Secondary Outcomes

Percent of patients with two completed Patient Reported Outcome Measures (PROMs)

The Michigan Oncology Quality Consortium (MOQC) OAA PROM, Patient Assessment Tool for Oral Chemotherapy is to be completed at 2 and 6 weeks after OAA initiation. This measure assesses the percent of patients who complete this PROM at both time points.

Time frame: Up to day 42 (+/-3) after OAA initiation

Percent of patients with completed Comprehensive Medication Reviews (CMRs)

Completed CMR includes initial and follow-up CMR with primary care pharmacist.

Time frame: Day 50 (+/-3) after OAA initiation

Percent of patients with scheduled Comprehensive Medication Review (CMR) within one week of first PROM result

The PROM is scored within one day after it is completed by the patient. The primary care pharmacist sets a date and time for the initial CMR after receiving the first scored PROM.

Time frame: Day 22 (+/-3) after OAA initiation

Percent of patients where oncology pharmacist reviewed PROM within 1 day of receiving scored PROM

The PROM is scored within one day after it is completed by the patient and is routed to the oncology pharmacist to review the results. The number of PROMs that are reviewed within 1 day of receipt will be assessed at 2 weeks and at 6 weeks.

Time frame: Up to day 44 (+/-3) after OAA initiation

Percent of CMRs where note was routed to oncology pharmacist

The number of CMR where note was routed to oncology pharmacist out of total number of completed CMRs, assessed at 2 weeks and at 6 weeks.

Time frame: Up to day 43 (+/-3) after OAA initiation

Percent of CMR notes that oncology pharmacist reviewed

The number of CMR notes reviewed by the oncology pharmacist out of the total number of completed CMRs, assessed at 2 weeks and at 6 weeks.