Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, C427 Med Inn, SPC 5843, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA.
Support Care Cancer. 2021 Nov;29(11):6505-6510. doi: 10.1007/s00520-021-06239-0. Epub 2021 Apr 27.
Nausea, vomiting, constipation, and diarrhea are common cancer and cancer therapy adverse effects. Pharmacists are uniquely positioned to optimize patient symptom control and minimize excess use of hospital resources, such as emergency department visits.
Michigan Medicine oncology clinical pharmacists have been independently providing patient symptom management through a collaborative drug therapy management (CDTM) program which established guidelines for management of gastrointestinal toxicities (nausea, vomiting, diarrhea, and/or constipation) secondary to a patient's cancer diagnosis or treatment of the cancer. Patients were referred to the pharmacist by the treating oncologist or hematologist.
From June 2019 to May 2020, there were a total of 62 patient referrals. Ten of the 62 referrals did not meet the CDTM inclusion criteria, resulting in 52 patients who were managed by the pharmacists. The total number of individual pharmacist visits was 136, with a median of 2.2 (range, 0-11) visits per patient referred. A total of 169 categorized pharmacist interventions were captured. Most interventions (100/169, 59.2%) were related to nausea/vomiting. Diarrhea-related and constipation-related interventions accounted for 10 (5.9%) and 13 (7.7%) of the total interventions, respectively. Most patients (36/52, 69.2%) had a reduction in the severity of their referral diagnosis symptom(s) based on Common Terminology Criteria for Adverse Events grading.
The Michigan Medicine Pharmacist CDTM program allowed pharmacists to independently manage gastrointestinal toxicities of patients with cancer and improved patient symptom severity. The CDTM program has the opportunity to improve quality of care.
恶心、呕吐、便秘和腹泻是常见的癌症和癌症治疗的不良反应。药剂师具有独特的优势，可以优化患者的症状控制，最大限度地减少对医院资源的过度使用，如急诊就诊。
密歇根大学医学肿瘤临床药剂师通过合作药物治疗管理（CDTM）计划独立为患者提供症状管理服务，该计划为因癌症诊断或癌症治疗而导致的胃肠道毒性（恶心、呕吐、腹泻和/或便秘）管理制定了指南。患者由治疗肿瘤学家或血液学家转介给药剂师。
从 2019 年 6 月到 2020 年 5 月，共有 62 名患者被转介。在这 62 名转介患者中，有 10 名不符合 CDTM 纳入标准，因此有 52 名患者由药剂师管理。药剂师的总访问次数为 136 次，中位数为每个转介患者 2.2 次（范围为 0-11 次）。共捕获了 169 项分类药剂师干预措施。大多数干预措施（100/169，59.2%）与恶心/呕吐有关。腹泻相关和便秘相关的干预分别占总干预的 10 项（5.9%）和 13 项（7.7%）。根据不良事件通用术语标准分级，大多数患者（36/52，69.2%）的转介诊断症状严重程度有所减轻。
密歇根大学医学药剂师 CDTM 计划使药剂师能够独立管理癌症患者的胃肠道毒性，并改善患者的症状严重程度。CDTM 计划有机会改善护理质量。
