Oncology Rounds

Don't know how to lower costs and raise quality? Your pharmacists do.

by Jacob Dingle and Deirdre Saulet

Although pharmacists are an integral part of the cancer care team, evidence suggests their skills are not being fully utilized. In the 2018 ACCC Trending Now in Cancer Care Survey, 89% of programs reported employing either pharmacists or pharmacy technicians, and 75% reported employing both types of staff.

Learn 6 tactics to make the most of your cancer care team

Oncology pharmacists and pharm techs often doing the same job—dispensing and mixing medications

While most organizations employ both of these roles, they seem to struggle to differentiate the roles from one another. In other words, the top responsibilities of a pharmacist are the same as pharmacy technicians' top responsibilities. These roles require vastly different education and credentials, yet most of their time is spent on overlapping tasks. Only 45% of respondents told us that their pharmacists provide staff education, and only 32% of respondents report that their pharmacists provide initial patient education on oral chemo, tasks that we would consider to be top of license for pharmacists.

To be fair, these tasks are untouched by pharm techs, a good sign of some proper differentiation. But leaving more basic tasks to your pharm techs can lead to increased efficiency for not only your pharmacists, but your providers.

Extending pharmacist role can help augment provider capacity

When practicing at top of license, pharm techs can handle most of the tasks we traditionally view as the pharmacist's role, such as dispensing and mixing drugs. This allow pharmacists to also practice at top of license and take on more patient-facing responsibilities, which can increase the care team's capacity.

For example, when physicians at the UNC Lineberger Comprehensive Cancer Center assessed the value of their clinical pharmacists in hematopoietic stem-cell transplant, they were able to demonstrate significant pharmacist contributions to revenue generation, time savings, and patient and staff satisfaction:

  • Revenue: Pharmacists generated approximately $23,000 in visit charges across six months, and generated an annual prescription revenue of approximately $840,000 in outpatient pharmacy.

  • Time: Over a six-week period, pharmacists saved physicians a total of 122 hours by taking on tasks such as securing preauthorizations and providing preadmissions counseling.

  • Satisfaction: UNC Lineberger physicians were highly satisfied with their pharmacist interactions, and patients reported high satisfaction as well.

It is important to keep in mind that employing pharmacists isn't cheap—in fact, according to Salary.com, the average pharmacist salary in the United States is $133,835. When cancer centers limit their pharmacists to dispensing medications despite their ability to alleviate workloads and save time across the care team, much of their value is lost.

Setting up your pharmacists for success

Take a look at how the following organizations made the most of their pharmacist team:

Multicare Regional Cancer Center (MRCC) a four-facility cancer program based in Tacoma, Washington, expanded the pharmacist role using a two pronged strategy: The cancer program focused first on procuring care team buy-in, and then on formalizing the partnership between pharmacists and physicians.

  • They started by giving pharmacists a physical presence to create organic opportunities for interaction with staff, and ensured top-down support by pushing compelling evidence to their leadership team;

  • They next prioritized easy wins, such as offloading time-consuming tasks form nurses that could benefit from a pharmacists expertise; and

  • Finally they developed nine collaborative practice agreements for specific events and procedures and an Oncology Supportive Care guideline that clearly outlines the pharmacists' role in patient care.

Since expanding the pharmacists' role, the cancer program has seen a steady decline in medication errors, including no-harm events for over two years.

St. Luke's MSTI, a nine-facility cancer program based in Boise, Idaho, implemented a pharmacist-led chemotherapy management program in which physicians submit orders for oral chemotherapy using a standardized form.

  • This alerts the pharmacist to a new oral chemotherapy patient, triggering them to work with the specialty pharmacy and ensure the patient fills the prescription; and

  • The pharmacist then follows up with the patient throughout treatment once a week during the first cycle, and one week prior to the beginning of subsequent cycles.

The program was a large success, leading to the tripling of internal specialty pharmacy prescriptions over a 16-month period, generating 2.4 million in estimated gross yearly revenues from prescriptions.

 

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6 ways your pharmacist can reduce costs and improve quality

From improving medication adherence to reducing hospital-acquired infections, pharmacists can play a significant role in critical organizational goals.

Our infographic outlines six pharmacist-led practices that can help improve patient outcomes and reduce overall health care spending. Download it now to get details about each practice, examples of how your peers put them into action, and the resulting impact on quality, safety, and cost reduction.

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