Development of Model of a Physician-Pharmacist Co-Managed Chronic Myeloid Leukaemia Clinic in a Tertiary Hospital in Hong Kong

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Authors (including presenting author) :
Chow LC(1), So KH(1), Chan MC(1), Lee SC(1), Wong SM(2)
Affiliation :
(1)Pharmacy Department, Prince of Wales Hospital, (2)Division of Haematology, Department of Medicine and Therapeutics, Prince of Wales Hospital
Introduction :
Patients with chronic myeloid leukaemia (CML) on BCR-ABL tyrosine kinase inhibitors (TKIs) who have attained major molecular response (MMR) are considered stable. In order to optimize pharmaceutical care and resource utilization, a collaborative physician-pharmacist co-managed CML clinic for these patients was proposed at Prince of Wales Hospital Haematology Specialist Out-Patient Clinic (SOPC). A pilot study was planned to evaluate its feasibility.
Objectives :
To develop a collaborative physician-pharmacist co-managed CML clinic model and to describe a pilot study to evaluate the feasibility of the model as part of development in local haemato-oncology pharmacy services.
Methodology :
The model was developed after consultation of other ambulatory care clinical pharmacy service models, CML clinical management pathway, and discussions with haematology consultant and oncology pharmacists. Three pilot study sessions were conducted in May to August 2018, in which pharmacist assessed patients before physician consultation using structured monitoring forms. The pharmacist documentations and physician’s consultation notes were reviewed for assessment of physician’s acceptance rate of pharmacist recommendations on CML monitoring plan in terms of TKI regimen and follow-up interval, number and type of potential drug-related problems (DRPs) identified and documented, and additional investigations arranged by physician.
Result & Outcome :
Fifty-two eligible patients attending the Haematology SOPC were identified. Clinic operation workflow, monitoring parameters, standardized case summary form and drug-specific monitoring forms, outcomes for service evaluation, and training and qualifications of pharmacist were developed. Thirteen patients were enrolled and evaluated in the pilot study. CML monitoring plan was recommended by pharmacist in twelve cases and were all accepted by physician. One case required discussion with physician due to unstable clinical condition. Forty-six potential DRPs were identified with over half (n=28, 60.9%) related to possible adverse drug events and nine (19.6%) related to potential drug interactions. Additional investigations were arranged by physician in four cases. Our data supported the physician-pharmacist collaborative model can effectively manage the CML condition and DRPs in these patients.

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