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Assistant Professor of Pharmacy Practice, Hematology/Oncology Clinical Pharmacist, Hematology/Oncology Specialty Residency Program Director, School of Pharmacy, Texas Tech University Health Science Center, Veterans Affairs North Texas Health Care System, Dallas, TX
Assistant Professor of Medicine, Chief of Hematology/Oncology Service, University of Texas Southwestern Medical School, Dallas Veterans Affairs Medical Center, Dallas
Assistant Professor of Pharmacy Practice, Primary Care Clinical Pharmacist, Specialty Residency Co-program Director, School of Pharmacy, Texas Tech University Health Science Center
Reprints: Dr. Shah, School of Pharmacy, Texas Tech University Health Science Center, Veterans Affairs North Texas Health Care System, 4500 S. Lancaster, Bldg. 7, Rm. 119A, Dallas, TX 75216-7167, fax 214/372-5020, sachin.shah{at}ttuhsc.edu
BACKGROUND: The Veterans Affairs North Texas Health Care System in Dallas, TX, provides a unique opportunity for clinical pharmacists to work as providers. Even though clinical pharmacists are actively involved in patient care, many of their efforts remain undocumented, resulting in an underestimation of the importance of their services and missed opportunities for improvements and new directions.
OBJECTIVE: To document and evaluate the services of a hematology/oncology clinical pharmacy in the outpatient setting.
METHODS: Pendragon Forms 3.2 software was used to design the documentation template. The template was designed to collect diagnoses, supportive care issues, drug-specific interventions, and prescriptions written. This template was uploaded to the personal digital assistant (PDA) for documentation. Patient-specific information was documented in a password-protected PDA. Data collected from November 1, 2002, to October 31, 2003, were retrospectively analyzed.
RESULTS: Clinical pharmacists were involved in 423 patient visits for chemotherapy follow-up or disease management. Cancer diagnoses included colorectal (n = 99), multiple myeloma (59), non-small cell lung (56), chronic lymphocytic leukemia (44), myelodysplastic syndromes (22), and chronic myelogenous leukemia (19). During the 423 patient visits, 342 supportive care issues were addressed including anemia (34%), pain management (22%), constipation/diarrhea (15%), and nausea/vomiting (8%). Major drug-specific interventions included drug addition (41%), discontinuation (23%), and adjustment (21%). Four hundred forty-five prescriptions were filled, of which 181 were new and 150 were refilled.
CONCLUSIONS: This is the first study, as of July 25, 2006, to document considerable contribution of an outpatient clinical pharmacist in direct cancer patient care. Although the disease management and supportive care issues addressed here may differ based on institution and patient population, the results of our study show that clinical pharmacists have ever-growing roles in the management of these patients.
Key Words: hematology, oncology, outpatient, pharmacy
Published Online, August 1, 2006. www.theannals.com, DOI 10.1345/aph.1H162
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