For the fifth year in a row, a Department of Pharmacy team at UNC Hospitals that includes UNC Eshelman School of Pharmacy faculty has been recognized by the American Society of Health-System Pharmacists with a National Best Practices Award.
The award recognizes outstanding practitioners who have implemented innovative systems and demonstrated best practices in health-system pharmacy. The UNC team was selected as one of six recipients in the country. The award-winning project is titled, “Impact of an Integrated, Closed-Loop, Pharmacy-Led Oral Chemotherapy Program on Clinical and Financial Outcomes.”
Because the medication management of patients with cancer is shifting away from infusion clinics to oral chemotherapy administered at home, the team built an integrated, closed-loop, pharmacy-led oral chemotherapy program. The project entailed building an off-site pharmacy to provide URAC-accredited specialty pharmacy services, as well as embedding specialized clinical pharmacists in the oncology clinics. The pharmacists worked directly with patients on education, adherence monitoring and adverse-effect management.
The award-winning team consisted of
- Benyam Muluneh, Pharm.D., adjunct assistant professor;
- Molly Schneider, Pharm.D., lead pharmacist of UNC Share Services Center Pharmacy;
- Aimee Faso, Pharm.D., adjunct assistant professor;
- John Valgus, Pharm.D., assistant professor of clinical education.
- Lindsey Amerine, Pharm.D., assistant professor of clinical education and assistant director of pharmacy at UNC Medical Center;
- Rowell Daniels, Pharm.D., executive associate dean of pharmacy for clinical practice, director of pharmacy at UNC Hospitals and associate professor of clinical education;
- Brett Crisp, Pharm.D., M.S., assistant professor of clinical education and clinical manager of the UNC Ambulatory Pharmacy Care Network; and
- Scott Savage, Pharm.D., assistant professor of clinical education and associate director of pharmacy at UNC Medical Center.
The study included 107 patients with varying malignancies, and there were a total of 350 patient encounters with clinical pharmacists.
In a survey conducted before the study, 93 participants reported less-than-optimal adherence, Muluneh said. Thirty percent of patients said they forgot to take their medications at least sometimes, and 21 percent intentionally cut back because of side effects or experienced delays in refilling their medication.
After the program was implemented, 85 percent of patients in the clinic for breast and gastrointestinal cancers were adherent as were 93 percent of patients in the clinic for blood cancers.
“We had clinical pharmacists embedded in these clinics managing patients independently. We had an accredited specialty pharmacy at that is certified to dispense the medication. We had a state that allows us to practice at the highest level of our pharmacy degree, and then we had a medical center and department of pharmacy that was very supportive of a high level of innovative pharmacy practice styles,” Muluneh said. “I think that the combination lead us to build something that was really great, and we thought that was very important to share that with the rest of our colleagues.”
After an average of nine months on therapy, the pharmacy-driven oral chemotherapy program led to a higher major molecular response rate (83 percent) in chronic myeloid leukemia patients, which is a gold standard associated with long-term survival in these patients, Muleneh said. The project’s MMR rates were superior to published clinical trials, which had average MMR rates of 40 percent and 60 percent with one-year and two-year follow up, respectively.
Muluneh said the team was thrilled to learn they had been recognized by the greater pharmaceutical community.
“We all knew what we were doing was unique and very innovative,” he said. “All of us believe, deep in our hearts, that we are doing our best for our patients in delivering this type of care.”
The project also had positive financial outcomes, as the clinic exceeded the $4 million in expected revenue. Muluneh said he hopes attention from the award will promote the project and help it continue to expand.
“This will hopefully allow us to collaborate with other institutions as well and further refine the process and potentially do a multicenter analysis of a similar project,” he said.
The team will be recognized and present their project at the Midyear Clinical Meeting in New Orleans.