Improved Patient Outcomes in a Multiple Myeloma Clinic

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As has been stated in previous Tips, pharmacists cannot operate in silos. Even among all the turf wars that exist, the best outcomes are usually the result of collaboration. Many pharmacy services are directed toward chronic illnesses such as diabetes and hypertension, because the majority of patients have to live with these diseases for a long time, and interventions can help save money and improve quality of life. But there are many instances where pharmacists working collaboratively can make an impact, including very acute diseases like cancer.

Swiss et al 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. In their study, 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, calcium and vitamin D, acyclovir, and pneumonia prophylaxis. Appropriate venous thromboembolism prophylaxis in immunomodulatory drug-treated patients was prescribed in 100% versus 83% of cases in the collaborative vs traditional clinic, respectively. The median time to initiation of bisphosphonate was shortened in a very substantial way (a few days vs nearly 100 days). The number of and duration of delays in obtaining drug therapy were also significantly reduced.

There are clinical endpoints, intermediate clinical outcomes, and process of care measures. While clinical endpoints are often the end goal, other outcomes measures are not unimportant. Pharmacy managers can work collaboratively to identify important outcomes for treatment in a broad array of diseases, such as in this case with adherence and also reduction in delays to time-sensitive medications for myeloma patients. There are so many ways that pharmacy services can be beneficial.

Additional information about Ensuring Quality in Pharmacy Operations and Implementing Value-Added Pharmacy Services can be found in Pharmacy Management: Essentials for All Practice Settings, 5e. If you or your institution subscribes to AccessPharmacy, use or create your MyAccess Profile to sign-in to Pharmacy Management: Essentials for All Practice Settings, 5e. If your institution does not provide access, ask your medical librarian about subscribing.

1Sweiss K, Wirth SM, Sharp L, et al. Collaborative physician-pharmacist-managed multiple myeloma clinic improves guideline adherence and prevents treatment delays. J Oncol Pract. 2018;14:e674-682.

Shane Desselle

Professor of Social and Behavioral Pharmacy, Touro University California