PHARMACISTS ROLE IN THE DEVELOPMENT OF A THERAPEUTIC PATIENT EDUCATION (TPE) PROGRAM BASED ON THE DIRECT ACTING ANTIVIRALS (DAA) USED IN CHRONIC HEPATITIS C TREATMENT.
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European Statement
Clinical Pharmacy Services
Why was it done?
It is now usual to dispense hepatitis C DAA to outpatients, whose virological success rate is high in the general population. However, subpopulations are at risk of re-infection or noncompliance for which an individualized approach with TPE is required. Role of the pharmacist is to transmit skills for starting and to assist the patient during treatment. SE are sometimes more easily disclosed to pharmacist, thereby allowing to take them into account so that the treatment can be adapted until completion. TPE benefits for these subpopulations are expected in the short term with regards to compliance and empowering the patient during treatment and in the long term to eliminate risky practices and leaving additions.
What was done?
setting up and running TPE sessions for hepatitis C by pharmacists
How was it done?
Hepatology department, based on multidisciplinary team (hepatologist physicians, psychiatrists, addiction specialists, pharmacists, nurses and psychologists), developed a TPE program on viral hepatitis in april 2016. Following written consent, entry into the program was systematically offered to vulnerable patients (background of substance abuse, active alcohol consumption, risk of non-compliance).
Pharmacists were involved in individual sessions concomitantly to DAA dispensing, since the day when patient started TPE program. Pharmaceutical sessions aimed outpatients to acquire following competencies:
– DAA’s name, action mechanism,
– Terms of administration, what to do if forgotten,
– Side effects (SE) and their management,
– Drug interactions (adapted to outpatient treatment).
Pharmacists also answered to questions concerning the patient and monitored compliance and SE.
Interactive practical tools were developed: treatment logbook (also allowed evaluating objectives at each session), cards about known and preconceived SE, timetable for drug intake. Patients fulfilled a satisfaction survey at last session.
What has been achieved?
31 outpatients were included. Pharmacists conducted 65 sessions, 2 or 3 individual meetings per patient (one hour-long total per pharmaceutical session) depending on treatment length (8-24 weeks). 6 patients were still ongoing and 25 achieved the program. Among them, 12 had an undetectable viral load after 12 weeks (Sustained Virological Response 12) and 1 relapsed. 100% of goals were achieved as from the first pharmaceutical session. 100% of patients were satisfied about pharmaceutical session
What next?
Evaluation of program’s benefits in terms of virological success need to be continued.
SESAME QUIZ: A PLAYFUL ONLINE QUESTIONNAIRE TO ASSESS PATIENTS’ KNOWLEDGE ABOUT SJOGREN’S SYNDROME
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European Statement
Education and Research
Author(s)
Charlotte Ménage-Anjuère, Rakiba Belkir, Elisabeth Bergé, Audrey Decottignies, André Rieutord, Xavier Mariette, Raphaèle Séror
Why was it done?
We needed to assess the impact of our patient education program on Sjogren’s syndrome (SESAME) in order to continuously improve it.
What was done?
A playful online questionnaire was designed and implemented to assess patients’ knowledge about Sjogren’s syndrome.
How was it done?
A interprofessional team (3 rheumatologists, 3 pharmacists) and a 4-patient group who participated in the education program together proceeded to the questionnaire design: 1) definition of a competency framework for patients with Sjogren’s syndrome; 2) from literature review, identification of quality requirements for a questionnaire (scientific quality, opportunity to interact, means of expression, logical chaining of questions, simplicity, utility, shortness, bias prevention, playfulness, variety, online diffusion). To fulfill these criteria, we used a clear vocabulary and concise questions, included open-ended questions on patient experience, focused on the artwork, randomized the order of answer choices, and shared the questionnaire online. Once the SESAME quiz was established, a scoring system was defined by the expert group. Face validity, feasibility and reproducibility were assessed to validate the questionnaire. 25 patients were contacted to complete the questionnaire twice. Patients also evaluated the content, structure and feasibility using 12 items (understandable language, unambiguous sentences, length of the questionnaire, difficulty, web access). Reproducibility was calculated using intraclass correlation coefficient (ICC) on patient answers separated by 48 hours.
What has been achieved?
The questionnaire includes 28 questions divided into 4 parts: Sjogren’s signs, Sjogren’s causes, treatment, daily life with the disease. The 25 patients filled in the questionnaire twice (96% women, 54 years min-max[23;74], 4 years since the diagnosis min-max[1;20]). The questionnaire was filled in from a computer (n=38), a tablet (n=3) or a smartphone (n=9). The average response time was 19 minutes. The median score was 34 points min-max[22;46] out of 50. 18 patients evaluated the questionnaire. 15 patients or more regarded its content, organization and feasibility as “very good”. 5 patients found it difficult. The reproducibility was very high (total ICC = 0.87 IC95% [0.74-0.94], ICC on each part between 0.61 et 0.87).
What next?
The SESAME quiz is now freely available (https://etp-rhumato.typeform.com/to/qsVhR1) and all the Hospital centers caring for Sjogren patients can use it for their follow up.
ESTABLISHING AN ACTIVE WORKING GROUP FOR PHARMACISTS WORKING WITHIN PAEDIATRIC ONCOLOGY AND HAEMATOLOGY IN SWEDEN, FINLAND, NORWAY AND DENMARK
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European Statement
Clinical Pharmacy Services
Author(s)
Ranaa El Edelbi, Joacim Götesson, Sanna Veijalainen, Mari Vanhatalo, Taija Heikkinen, Ulla Taipale, Gunn-Therese Lund Sørland, Margrete Einen, Magnus Dahlander
Why was it done?
There is a great need for pharmaceutical expertise within the field of pediatric oncology and hematology, where chemotherapeutic regimens and supportive therapy often require intense treatment with drugs from many therapeutic groups. The complex drug environment created requires competence in diverse pharmaceutical subjects and many centers of pediatric oncology and hematology within NOPHO has concluded that hiring a pharmacist can cover the perceived knowledge gap and also increase the quality of the drug treatment. However, working as a single clinical pharmacist in a very specialized hospital setting such as pediatric oncology and hematology can be very difficult and time-consuming as everything depends on your own knowledge and experience. In most pediatric oncology and hematology centers it is not feasible to have more than one pharmacist and thus collaboration and discussion between different hospitals and countries are necessary.
What was done?
A working group for pharmacists was established within the Nordic Society of Paediatric Haematology and Oncology (NOPHO).
How was it done?
The need for a group of pharmacists working within pediatric oncology and hematology was raised by pharmacist Ranaa El Edelbi at Astrid Lindgren’s Children’s Hospital, Stockholm, during the autumn of 2014. She sent out an email to all the pediatric oncology and hematology centers within NOPHO and asked if they had any pharmacists involved in the care setting. She got a positive reply from a few centers and invited the pharmacists for at first meeting in Stockholm in November 2014 and a working group for pharmacists with NOPHO was created in early 2015. The network has since then grown to 17 pharmacists from 4 countries and 10 centers.
What has been achieved?
An active working group with regular email discussions as well as Skype and physical meeting to facilitate the exchange of knowledge and experience. The group has also undertaken and finished a project to develop a guideline for extravasation of chemotherapeutic drugs, which was published in December 2016.
What next?
Developing a guideline for safe and accurate administration of oral chemotherapeutic drugs to children.
IMMPACT: A THERAPEUTIC EDUCATION PROGRAM TO SUPPORT SEAMLESS CARE FOR PATIENTS LIVING WITH CANCER
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European Statement
Clinical Pharmacy Services
Author(s)
A. Decottignies, D. Bouchoucha, S. Lévêque, S. Barthier, J.F. Morere, A. Marfaing, A. Rieutord
Why was it done?
Cancer has become a chronic disease. However, the impact of the disease and related treatments on patients’ everyday life remain poorly addressed all along the patient clinical pathway. The objective was to customise support to the patient to be able to better understand and control the disease and treatment consequences.
What was done?
An integrated care model based on a therapeutic education programme (TEP) was designed to better support patients living with cancer in their everyday life. The hospital pharmacy led the project, launched in October 2013 and implemented for patients in March 2015. It is called IMMPACT (impact of illness and medication in patients undergoing chemotherapy). This TEP was accredited by the National Authority (ref No ETP 13/30 in August 2013).
How was it done?
A transprofessional working group was formed. Our concern was to propose a smooth and safe transition from hospital to home. To do so, the hospital set up a partnership with the health network to facilitate seamless care. A prospective survey was conducted in October 2013 including 41 ambulatory patients. Three priority themes were identified: tiredness, haematological problems and digestive disorders management. According to the results, educational sessions have been collaboratively designed and implemented.
What has been achieved?
The patients group workshops began in January 2014. To date, 31 group workshops have been run. These group workshops are facilitated by trained healthcare professionals using educational tools such as Barrows Cards, mosaic characters or metaplan. 83 patients have already experienced this programme. Patient global satisfaction is >92%.
What next?
Given the success of this programme and to fulfil the growing expectations of patients, new sequences are being designed about pain, chemotherapy related neurotoxicity, socio-aesthetics and lymphoedema management as well as developing a serious game for the patient. Finally, IMMPACT extension to community pharmacists is being considered to further sustain patients empowerment and continuity of care.
Safe and integrated onco-hematology workflow
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European Statement
Production and Compounding
IMPLEMENTING CHEMOTHERAPY DOSE-BANDING USING RETROSPECTIVE DATA ANALYSIS AND EXPONENTIAL CALCULUS
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European Statement
Production and Compounding
Why was it done?
Chemotherapies are generally prescribed and produced as a function of Body Surface Area (BSA). The most recent literature recommends that marketed drugs continue to use BSA-based dosing supported by clinical evidence. If not, it recommends DB with adjustments for other important parameters.
What was done?
Determine which of the drugs compounded in our centralised chemotherapy production unit were potential candidates for dose banding (DB) for adults, whilst guaranteeing patient safety and meeting the needs of physicians, pharmacists and nurses.
How was it done?
The database of chemotherapy doses produced between 2010 and 2013 was analysed to define a Top 10 chart of the most common protocols and compounds. Dosage patterns were analysed and new bands were modelled using exponential calculus in order to aid in DB decision-making. Discussions with interdisciplinary teams and senior physicians took place in order to promote acceptance of the project and its deployment.
What has been achieved?
Oncology professionals requested an integration of bands into the electronic prescription system, the possibility to prescribe doses above those suggested using BSA and a maximum 5% margin of difference to the usual prescribed dose. They highlighted the necessity of maintaining “ready for administration” doses. For example, in 2013, 613 infusion bags of gemcitabine were produced in 111 different doses, ranging from 266 to 2900 mg. Following the new specifications, just two bands (2000 mg and 1805 mg) already fulfil 50% of annual production needs; producing five band doses streamlines 90% of annual production needs.
What next?
Chemotherapeutic doses can now be prepared in bands and the pharmacy activity can be rationalised by producing doses in batches. The imminent introduction of automation should ensure accuracy of the doses delivered. Future studies should examine product stability so that chemotherapy production planning becomes highly efficient.
DEVELOPMENT AND IMPLEMENTATION OF GUIDELINES FOR THE SAFETY MANAGEMENT OF INTRATHECAL CHEMOTHERAPY IN PATIENTS WITH HEMATOLOGICAL MALIGNANCIES
Pdf
European Statement
Patient Safety and Quality Assurance
What has been achieved?
.
HIGHLY ACTIVE ANTIRETROVIRAL THERAPY PRESCRIPTIONS IN NAIVE PATIENTS: IMPROVEMENT PLAN
Pdf
European Statement
Patient Safety and Quality Assurance
Author(s)
A. Rodríguez-Perez, M.I. Sierra-Torres, M.D. Toscano-Guzmán, A. Monzón-Moreno, M. Soriano-Martinez, A. Lluch-Colomer, M.D. Santos-Rubio
Why was it done?
According to the guidelines and recommendations for the rational use of medication, prescriptions of HAARTs must be standardised following the principles of efficiency and based on the best evidence available.
What was done?
A multidisciplinary group of clinical pharmacists and physicians made an easy-to-read handout that summarised the main recommendations of GESIDA for the treatment of naive patients, treated with highly active antiretroviral therapy (HAART). The hand-out consisted of a table with the allowed and not-allowed antiretroviral combinations and the exceptions. The multidisciplinary group disseminated the handout to the prescribers through clinical sessions. The multidisciplinary group made a 6 month study to evaluate the adherence to GESIDA, previous and after the implementation of the easy-to-read handout.
How was it done?
We did not have any problem implementing these recommendations or organizing the clinical sessions.
What has been achieved?
The multidisciplinary group made a retrospective study of the 6-months previous the implementation of the handout, by a chart review of the prescriptions. One hundred naive patients were evaluated. We found an eleven per cent of deviations of the recommendations, none of them justified. The multidisciplinary group made a prospective study during a 6-months period after the implementation of the handout, by a chart review of the prescriptions. Seventy-one naive patients were evaluated. We found a 7% of deviations of the recommendations, three of them were justified because of co-morbidity that contraindicated the recommended medication. We also made a follow-up of the treatment of the patients of the retrospective study, six of the eleven patients of that group changed their HAART to the recommended ones.
What next?
The multidisciplinary team has periodic meetings to evaluate the adherence to the recommendations and to study news reported by GESIDA. The economic impact of the practice is planned to be evaluated.