McBride Ali, Campen Christopher J, Camamo James, Maloney Marie, Persky Daniel, Kurtin Sandra E, Barket Nikki L, Krishnadasan Ravitharan, Elquza Emad, Anwer Faiz, Weibel Kurt
University of Arizona Cancer Center, Tucson, AZ
Greenville Health System Cancer Institute, Greenville, SC.
Am J Health Syst Pharm. 2018 May 1;75(9):e246-e258. doi: 10.2146/ajhp170138.
Implementation of a pharmacy-managed program for the transition of chemotherapy to the outpatient setting is described.
The University of Arizona Cancer Center and Banner-University Medical Center Tucson are affiliated not-for-profit academic medical centers in Tucson, Arizona, whose facilities include a hospital and ambulatory care clinics that maintain 3 outpatient infusion centers. The cancer center pharmacy currently employs 25 pharmacists, with 4 clinical pharmacists serving both the inpatient and outpatient treatment sites. A multidisciplinary team of staff members was assembled to address the transition of chemotherapy from inpatient to outpatient that included physicians, ambulatory clinical oncology pharmacists, finance, social workers, pharmacy staff, nursing staff, and information technology. The program was initiated in May 2014, with a 2-year postimplementation evaluation of our transition of chemotherapy to the outpatient setting. Chemotherapy order sets were developed in our electronic medical record for transitioning rituximab to the outpatient setting for inpatient chemotherapy orders as well as transitioning leukemia, lymphoma, and solid tumor chemotherapy regimens to be administered in the outpatient setting. Eighteen rituximab-containing regimens and 14 chemotherapy protocols were switched to the outpatient setting, with numerous variants of these regimens also created for outpatient only administration. The realized savings for high-cost chemotherapy transitioned to the outpatient setting with rituximab and clofarabine was $1,902,890. Over 747 inpatient bed days were saved, with an approximated cost savings to the health system of $1,402,866, with a cumulative cost savings to our health system of $3,305,756.
This model for transitioning chemotherapy from the hospital to the outpatient setting enhanced access to care, decreased bed utilization in the hospital, and improved clinical and financial metrics.
描述一项由药房管理的将化疗过渡到门诊环境的项目实施情况。
亚利桑那大学癌症中心和图森班纳大学医学中心是位于亚利桑那州图森的非营利性学术医疗中心，其设施包括一家医院和门诊护理诊所，设有3个门诊输液中心。癌症中心药房目前有25名药剂师，其中4名临床药剂师同时服务于住院和门诊治疗点。组建了一个多学科工作人员团队来解决化疗从住院向门诊的过渡问题，团队成员包括医生、门诊临床肿瘤药剂师、财务人员、社会工作者、药房工作人员、护理人员和信息技术人员。该项目于2014年5月启动，对化疗向门诊环境的过渡进行了为期2年的实施后评估。在我们的电子病历中制定了化疗医嘱集，用于将利妥昔单抗从住院化疗医嘱过渡到门诊环境，以及将白血病、淋巴瘤和实体瘤化疗方案过渡到门诊环境给药。18种含利妥昔单抗的方案和14种化疗方案被转换到门诊环境，还为仅在门诊给药创建了这些方案的许多变体。利妥昔单抗和氯法拉滨向门诊环境过渡的高成本化疗实现节省1,902,890美元。节省了超过747个住院床日，估计为卫生系统节省成本1,402,866美元，我们的卫生系统累计节省成本3,305,756美元。
这种将化疗从医院过渡到门诊环境的模式增加了医疗服务的可及性，降低了医院床位利用率，并改善了临床和财务指标。
