Establishing clinical pharmacist telehealth services during the COVID-19 pandemic.

PURPOSE: After community transmission of the novel virus that causes coronavirus disease 2019 (COVID-19) was detected in the State of Washington in February 2020, innovative measures, such as telehealth appointments, were needed to safely continue to provide optimal pharmaceutical care for patients with chronic conditions and cancer. SUMMARY: Prior to the COVID-19 pandemic, federal regulations limited the scope of telehealth pharmacist services. However, enactment of the Coronavirus Preparedness and Response Supplemental Appropriations Act, followed by guidance by the Centers for Medicare and Medicaid Services and the Department of Health and Human Services, allowed currently credentialed providers (including pharmacists) to continue to provide patient care services via telehealth with fewer restrictions. Our health system has numerous credentialed pharmacists across multiple ambulatory care clinics. In this article, we highlight our process of expediting the implementation of telehealth services. This process included obtaining authorization for the credentialed pharmacists to provide telehealth services, completion of training modules, implementation of new technology platforms, development of new workflows, and utilization of resources for providers and patients to facilitate successful completion of telehealth visits. We also highlight the consent and documentation components crucially important to the telehealth visit and share some of our successes, as well as identified limitations, in providing pharmacist services via telehealth. CONCLUSION: In the setting of the COVID-19 pandemic, our institution was able to swiftly implement clinical pharmacist telehealth services for many patients, offering a safe and effective way to continue providing a high level of care. This article discusses our experience with and potential limitations of telehealth to assist other pharmacists seeking to implement and/or expand their telehealth services.

Expanding pharmacy practice through the use of pharmacy technicians as process navigators to facilitate patient access of oral anticancer agents.

OBJECTIVES: Over the past 20 years, there has been an increase in the number of Food and Drug Administration-approved oral anticancer agents. Treatment with the use of these medications can offer patients many benefits, including increased convenience and improved quality of life. However, oral anticancer therapies are associated with significant challenges, including cost and difficulties in obtaining the medication. SETTING: Oncology pharmacists and nurses at the Seattle Cancer Care Alliance oversaw the entire process of oral anticancer therapies, from obtaining signatures and insurance authorization to completing patient education and sending the prescription to the preferred pharmacy. This often led to duplicative efforts and challenges with communication amongst all the team members. PRACTICE DESCRIPTION: The pharmacy department piloted a trained pharmacy technician who was provided the role of process navigator to facilitate and coordinate the entire insurance authorization and patient assistance process involved in obtaining access to oral anticancer medications. Before implementation of the program, the average time spent in total for each oral anticancer prescription was 45.8 minutes for the clinic nurses, 21.8 minutes for the clinical pharmacists, and 45.8 minutes for the pharmacy billing technicians. There was an 89.7% success rate in obtaining these medications for patients. RESULTS: After implementation of this program, the pharmacy technician serving as the process navigator significantly improved efficiency and required an average of 59.5 minutes to complete the same steps, compared with 114 minutes before implementation. After program implementation, it was also observed that the pharmacist and nurse were spending much less time on the insurance authorization process. After implementation of this new role, the success rate of obtaining oral anticancer medications increased to 93.1%. CONCLUSION: This innovative initiative expanded the scope of practice for pharmacy technicians and enabled the other team members to spend time on more clinical activities.

Influence of obesity on efficacy and toxicity of induction chemotherapy in patients with newly diagnosed acute myeloid leukemia.

Increased body mass index (BMI) is associated with increased risk of treatment-related complications and inferior overall survival in patients with acute myeloid leukemia (AML). We retrospectively evaluated the association between percentage of ideal body weight (IBW) and complete remission (CR) among 63 newly diagnosed, previously untreated patients with AML. The median percentage of ideal body weight was 121% (range 86-246%). Thirty-three percent of patients were obese (≥ 130% IBW). In multivariate analysis, obesity was not associated with CR (odds ratio [OR] = 0.97, p = 0.88), overall survival (hazard ratio = 0.48, p = 0.52), platelet recovery by 30 days (OR = 1.14, p = 0.52) or neutrophil recovery by 30 days (OR = 1.12, p = 0.60). Obesity was also not associated with any differences in non-hematologic toxicity. CR rates were not significantly different comparing patients not dose-adjusted to patients with obesity-related adjustments (CR = 86% vs. 67%, p = 0.55). Empiric dose reductions based on obesity did not result in significantly different CR rates.