Health Outcomes and Research, Vanderbilt University Medical Center, Nashville, TN.
Specialty Pharmacy Services, Vanderbilt University Medical Center, Nashville, TN.
J Manag Care Spec Pharm. 2023 Jul;29(7):740-748. doi: 10.18553/jmcp.2023.29.7.740.
New oral oncology medications bring novel challenges when patients are initiating treatment. Rates of primary medication nonadherence (PMN), the rate at which a medication is prescribed but not obtained, of up to 30% have been reported for oral oncology medications. More research is needed to identify causes and develop strategies for health system specialty pharmacies (HSSPs) to improve cancer treatment initiation rates. To evaluate the rate and reasons for PMN to specialty oral oncology medications in an HSSP setting. We performed a multisite retrospective cohort study across 7 HSSP sites. Patients were included if they had an orally self-administered oncology medication referral generated by the health system of the affiliated specialty pharmacy between May 1, 2020, and July 31, 2020. Data collected at each site using pharmacy software and the electronic health record were deidentified and aggregated for analysis. After identifying unfilled referrals within a 60-day fill window, a retrospective chart review was performed to identify final referral outcomes and reasons for unfilled referrals. Referral outcomes were categorized as unknown fill outcomes (because of being referred to another fulfillment method or if received for benefits investigation only), filled by the HSSP, or not filled. The primary outcome was PMN for each PMN-eligible referral and secondary outcomes included reason for PMN and time to fill. The final PMN rate was calculated by dividing the number of unfilled referrals by total referrals with a known fill outcome. Of 3,891 referrals, 947 were PMN eligible, representing patients with a median age of 65 years (interquartile range = 55-73), near equal distribution between male and female (53% vs 47%), and most commonly with Medicare pharmacy coverage (48%). The most referred medication was capecitabine (14%), and the most common diagnosis was prostate cancer (14%). Among PMN-eligible referrals, 346 (37%) had an unknown fill outcome. Of the 601 referrals with known fill outcome, 69 referrals were true instances of PMN, yielding the final PMN rate of 11%. Most referrals were filled by the HSSP (56%). Patient decision was the most common reason for not filling (25%; 17/69 PMN cases). The median time to fill after initial referral was 5 days (interquartile range = 2-10). HSSPs have a high percentage of patient initiation of new oral oncology medication treatments in a timely manner. More research is needed to understand patient reasons for deciding not to start therapy and to improve patient-centered cancer treatment planning decisions. Dr Crumb was a planning committee member with Horizon CME for the Nashville APPOS 2022 Conference. Dr Patel received funding and support for attending meetings and/or travel from the University of Illinois Chicago College of Pharmacy.
新的口服肿瘤药物在患者开始治疗时带来了新的挑战。据报道，高达 30%的口服肿瘤药物出现原发性药物不依从（PMN），即药物开处方但未获得。需要更多的研究来确定原因，并为专业药房的医疗系统制定策略，以提高癌症治疗的起始率。为了评估在专业药房环境下口服肿瘤药物的 PMN 发生率和原因，我们对 7 个专业药房进行了一项多地点回顾性队列研究。如果患者有由附属专业药房的医疗系统生成的口服肿瘤药物转介，并且在 2020 年 5 月 1 日至 2020 年 7 月 31 日之间在药房软件和电子健康记录中收集数据，则纳入研究。在 60 天的用药窗口内确定未填写的转介后，进行回顾性图表审查以确定最终转介结果和未填写的原因。转介结果分为未知用药结局（因为被转介到另一种用药方式或仅为受益调查而接受）、由专业药房完成或未完成。主要结局是每个 PMN 合格转介的 PMN，次要结局包括 PMN 的原因和用药时间。最终的 PMN 发生率通过将未填写的转介数除以具有已知用药结局的总转介数来计算。在 3891 个转介中，947 个符合 PMN 标准，代表中位年龄为 65 岁（四分位距=55-73）的患者，男女分布几乎相等（53% vs 47%），最常见的是医疗保险药房覆盖（48%）。最常转介的药物是卡培他滨（14%），最常见的诊断是前列腺癌（14%）。在 PMN 合格的转介中，346 个（37%）有未知的用药结局。在 601 个已知用药结局的转介中，69 个是真正的 PMN 病例，最终 PMN 发生率为 11%。大多数转介由专业药房完成（56%）。患者决定是不填药的最常见原因（25%；69 例 PMN 中有 17 例）。首次转介后，中位用药时间为 5 天（四分位距=2-10）。专业药房能及时为大多数新口服肿瘤药物治疗的患者提供治疗。需要更多的研究来了解患者决定不开始治疗的原因，并改善以患者为中心的癌症治疗计划决策。Crumb 博士是 Horizon CME 举办的纳什维尔 APPOS 2022 会议的规划委员会成员。Patel 博士获得了伊利诺伊大学芝加哥药学院参加会议和/或旅行的资金和支持。
