University of Illinois at Chicago, Chicago, IL.
J Oncol Pract. 2018 Nov;14(11):e674-e682. doi: 10.1200/JOP.18.00085.
We hypothesized that a multidisciplinary collaborative physician-pharmacist multiple myeloma clinic would improve adherence to treatment and supportive care guidelines as well as reduce delays in receiving oral antimyeloma therapy.
From March 2014 to February 2015, an oncology pharmacist provided consultation for all patients in a specialist myeloma clinic. This included reviewing medications, ensuring physician adherence to supportive care guidelines, managing treatment-related adverse effects, and navigating issues involving access to oral specialty medications (collaborative clinic).
Outcome measures were retrospectively compared with those of patients being treated by the same physician during the previous year, in which ad hoc pharmacist consultation was available upon request (traditional clinic). The collaborative clinic led to significant improvements in adherence to supportive medications, such as bisphosphonates (96% v 68%; P < .001), calcium and vitamin D (100% v 41%; P < .001), acyclovir (100% v 58%; P < .001), and Pneumocystis jirovecii pneumonia prophylaxis (100% v 50%; P < .001). Appropriate venous thromboembolism prophylaxis in immunomodulatory drug-treated patients was prescribed in 100% versus 83% of cases ( P = .0035). The median time to initiation of bisphosphonate (5.5 v 97.5 days; P < .001) and P jirovecii pneumonia prophylaxis after autologous transplantation was shortened in the collaborative clinic (11 v 40.5 days; P < .001). Furthermore, the number (85% v 21%; P < .001) and duration (7 v 15 days; P = .002) of delays in obtaining immunomodulatory drug therapy were also significantly reduced.
Our collaborative clinic model could potentially be applied to other practice sites to improve the management of patients with multiple myeloma. Prospective studies analyzing clinical outcomes, patient satisfaction, and cost effectiveness of this approach are warranted.
我们假设一个多学科合作的医生-药剂师多发性骨髓瘤诊所将改善对治疗和支持性护理指南的依从性，并减少接受口服抗骨髓瘤治疗的延迟。
从 2014 年 3 月到 2015 年 2 月，一名肿瘤药剂师为专科骨髓瘤诊所的所有患者提供咨询。这包括审查药物，确保医生遵守支持性护理指南，管理与治疗相关的不良反应，并解决涉及获得口服专科药物的问题（合作诊所）。
回顾性比较了在同一医生治疗的患者的结果测量值，在该诊所中，按需提供临时药剂师咨询（传统诊所）。合作诊所显著提高了对支持性药物的依从性，如双磷酸盐（96%比 68%；P<0.001）、钙和维生素 D（100%比 41%；P<0.001）、阿昔洛韦（100%比 58%；P<0.001）和卡氏肺孢子虫肺炎预防（100%比 50%；P<0.001）。在接受免疫调节剂治疗的患者中，适当的静脉血栓栓塞预防的处方率为 100%比 83%（P=0.0035）。在合作诊所中，双磷酸盐（5.5 比 97.5 天；P<0.001）和自体移植后卡氏肺孢子虫肺炎预防的起始中位时间缩短（11 比 40.5 天；P<0.001）。此外，获得免疫调节剂治疗的时间（85%比 21%；P<0.001）和持续时间（7 比 15 天；P=0.002）也显著减少。
我们的合作诊所模式有可能应用于其他实践场所，以改善多发性骨髓瘤患者的管理。需要进行前瞻性研究，分析这种方法的临床结果、患者满意度和成本效益。
