2025 Southeastern Residency Conference

Title: IMPACT OF PHARMACIST-LED TRANSITIONS OF CARE SERVICES FOR PATIENTS DISCHARGING ON ORAL CHEMOTHERAPY


Authors: Nathan Park, Courtney Mallon, Ashley Mull


Objective: To determine the effect of pharmacist-led transitions of care services for patients discharging on oral chemotherapy at the University of Tennessee Medical Center.


Background:
Oral anticancer therapies have changed the course of therapy in a growing number of malignancies that have traditionally been managed with intravenous (IV) chemotherapy. The increasing use of oral anticancer therapies benefits patient convenience and quality of life. However, several challenges now exist for patients from medication procurement, adherence, and safe handling and administration of these agents. Pharmacists are uniquely trained to improve outcomes through increased medication adherence, patient knowledge, and drug monitoring. This study aims to determine the effect of pharmacist-led transitions of care (TOC) services for patients discharging on oral chemotherapy at the University of Tennessee Medical Center.


Methods:
This prospective, single-center, quality improvement initiative included adult patients being discharged from the inpatient oncology service who filled a prescription for an oral chemotherapy at the University of Tennessee Specialty Pharmacy from January 1^st, 2024 to October 1^st, 2024. The primary endpoint was the average number of interventions made by oncology pharmacists regarding oral chemotherapy prescribed at discharge. Interventions included in the study included: drug-drug interactions, drug-disease clarification, dosing adjustments (non-renal/hepatic/toxicity), toxicity adjustment, drug acquisition, renal adjustments, hepatic adjustments, and other interventions. Secondary endpoints were the average number of interventions made within 1 week of discharge and the length of time in days between the prescription being sent to the pharmacy and the patient receiving their medication. 


Results:
A total of 23 patients were included in the study. At time of discharge, a total of 10 interventions were made with the average number of interventions per patient being 0.43. Of the 10 interventions made at discharge, five of them were involving drug acquisition. At follow-up, four interventions were made for an average number of interventions per patient of 0.17. All follow-up interventions involved patient counseling. The average length of time for patients to receive their medication was 8.83 days with a median (IQR) time of 4 (6.5) days. 


Conclusion:
Pharmacists most frequently intervened at time of discharge with most interventions being related to drug acquisition. Follow-up calls resulted in fewer interventions, but all interventions involved patient counseling. The study supports the need for further pharmacist involvement with transitions of care services.