RESUMO
INTRODUCTION: The integration of clinical oncology pharmacists into multidisciplinary healthcare teams is not well-described in the community practice setting. This study aims to analyze the clinical and financial impact of a remote-based clinical oncology pharmacist in four community oncology practices within The US Oncology Network. METHODS: Oncology-trained clinical pharmacists electronically reviewed chemotherapy orders for clinical optimization and financial stewardship within four community oncology practices. Each pharmacist was appointed at 0.5 full-time equivalents per practice. Financial, clinical, and workload metrics were tracked to monitor the impact of pharmacist engagement. RESULTS: Over 12 months, 5716 order reviews were completed with an intervention rate of 57%. The most common interventions identified by the pharmacists were interventions with clinical impact on the patient (36%), followed by dose rounding (35%) and therapeutic interchange (30%). Overall, interventions improved the cumulative practice margins by $1,455,033 and reduced total medication costs by $5,962,551. The average program return on investment was 415% (range 100-915%). CONCLUSION: Community oncology practices seek to provide high-value care in a lean, resource-constrained model. An oncology clinical pharmacist is a cost-effective and clinically invaluable care team member in community oncology practice. Pharmacists in this setting identified opportunities to improve medication safety and regimen optimization and demonstrated a significant tremendous financial impact on small-scale budgets in community oncology.
Assuntos
Oncologia , Farmacêuticos , Humanos , Serviços de Saúde Comunitária , TelemedicinaRESUMO
We examined the response of demographic, morphological, and chemical parameters of turtle grass (Thalassia testudinum), to much-higher-than-normal rainfall associated with an El Niño event in the winter of 1997-1998. Up to 20 inches of added rain fell between December 1997 and March 1998. triggering widespread and persistent phytoplankton blooms along the west coast of Florida. Water-column chlorophyll concentrations estimated from serial Sea WiFS imagery were much higher during the El Niño event than in the previous or following years, although the timing and magnitude of phytoplankton blooms varied among sites. Seagrass samples collected in 1997, 1998, and 1999 provided an excellent opportunity to test the responsiveness of Thalassia to decline and subsequent improvement of water quality and clarity in four estuaries. Using a scoring technique based on temporal responsiveness, spatial consistency, and statistical strength of indicators, we found that several morphological parameters (Thalassia shoot density, blade width, blade number, and shoot-specific leaf area) were responsive and consistent measures of light stress. Some morphological parameters, such as rhizome apex density, responded to declines and subsequent improvement in water clarity, but lacked the statistical discriminating power necessary to be useful indicators. However, rhizome sugar, starch, and total carbohydrate concentrations also exhibited spatially and temporally consistent variation as well as statistical strength. Because changes in shoot density, as well as water clarity, affect rhizome carbohydrate levels, a composite metric based on Thalassia shoot density and rhizome carbohydrate levels together is probably more useful than either parameter alone as an indicator of seagrass health.
