I recently had a chance to read the article Pharmacy-Led Monitoring of Oral Chemotherapy by Jay M. Patel, PharmD and Christopher Niemann, PharmD in November’s issue of Pharmacy Purchasing & Products. If you have the time, check it out. This article brings up a number of important issues about the pharmacist role, oral chemotherapy, and how to best support patients through the treatment process.
As an experienced Hospice and Oncology nurse and member of the RxTOOLKIT® team, I wanted to share some thoughts about these issues and provide perspective on how the evolution of technology has provided increased potential to improve medication adherence.
In this article, the authors document how a pharmacist-led oral cancer therapy-monitoring program resulted in many positive outcomes. I personally feel the inclusion of pharmacists as part of the direct care team, especially in the care of high-risk patients, is long overdue and unquestionably in the patient’s best interest. Pharmacists are medication experts; it’s what they do. Pharmacists provide expertise in medication therapy management and assist with toxicity monitoring/management, drug-drug interactions, and cost-related issues. I strongly agree that involving the pharmacist in direct care provides a greater opportunity to increase positive patient outcomes.
The authors also address the increasing number and prevalence of oral chemotherapy agents currently being prescribed. Nearly half of all new chemotherapy drugs in development are oral agents! It is important to realize the convenience of a pill does not decrease the toxicity of these agents. These oral agents are just as toxic as their intravenous forms and must be handled and monitored as hazardous drugs. As the use of these drugs increases, so does the need for more direct patient involvement and improved safety education for both patients and staff.
Medication adherence in oral chemotherapy is of the utmost importance for a successful outcome. As an oncology nurse, I often worried about my patients taking an incorrect dose or handling their drugs improperly. Oral chemotherapy regimens are often very complicated and patients must take multiple pills for each dose. I often saw patients who were overwhelmed by the amount of information they were given. They often have difficulty remembering when and how to properly take their medications.
Self-administered oral chemotherapy places new demands on the direct care team as well as patients and families who must now self-manage their own complex medication regimen. As the authors mention, collaborative relationships between health care providers and patients, as well as appropriate patient education, are perhaps the most important factors to ensure proper management and adherence.
Recently, during my graduate program, I completed an evidence based research project regarding medication adherence. Poor medication adherence in adults with chronic illness contributes to poor health outcomes, increased healthcare costs, and is estimated to contribute to approximately 125,000 preventable deaths each year. It is estimated $110–300 billion is wasted annually on lack of medication adherence. As this article points out, suboptimal adherence may also result in disease or treatment complications, including disease progression and premature death. This is the difficult reality as healthcare providers we strive to avoid! This is a vulnerable population facing high-risk treatments with potentially life threatening outcomes.
Through my research I closely examined many of the current forms of adherence monitoring mentioned in this article such as serum drug levels, refill records, patient self-reporting, patient medication diaries, and microelectronic event monitoring systems (MEMS). My research proved these methods to often be inaccurate, unreliable, or cost prohibitive.
I began to look for a better way. I found the inspiration right in front of my nose (and many people’s noses)…a smart phone! I started to research whether a mobile device could be used as a tool to improve medication adherence.
My research revealed numerous studies that support a significant improvement in medication adherence in patients with chronic illness through the use of mobile devices. Specifically, by providing real time communication it closes the communication gap between patient and provider, which increases patient engagement. This was conclusively shown to help prevent:
- Patients seeking care in the ED or readmission by increasing reports of symptoms or adverse reactions
- Patients missing medication doses as a result of forgetfulness
- Patients taking the wrong medication, wrong dose of medication, or having uncertainty about their medication regime
I knew I was really on to something. Combining the best attributes of mobile device interventions into a useful mobile application as a recommendation for practice became an objective of my research project as well as a personal goal!
I began to work directly with the RxTOOLKIT® development team. Over the past several months we have developed the application RxHomeMed™ for Outpatient, which is soon to be released. This versatile application provides home medication verification and labeling, using scannable barcodes, designed specifically to track and document a patients’ home medication adherence…all with a cell phone or tablet!
RxHomeMed™ for Outpatient is an easy to use mobile app for patients. It is cost effective and easy to implement. With many optional features and complete customization you can tailor RxHomeMed™ to meet a patients’ specific needs.
RxHomeMed™ for Outpatient:
- Promotes patients’ medication adherence
- Increases communication on all levels
- Provides a patient specific label that follows ALL of the ISMP guidelines for safe drug product labeling
- Provides easy scanning with any smart phone or tablet enabling patients to accurately report and store an unlimited history of self-administered medication doses
- Provides reliable documentation in medication adherence reports which are easily imported into the patient’s EHR with a simple barcode scan
- Offers a built-in report feature that provides complete QA (Quality Assurance) documentation, is automatically generated, and easily searchable by patient name, medical record number, date of birth, or date of drug entry
- Includes an optional feature incorporating questions that screen for common side effects
Mobile App Features:
- Works with ANY smart phone or tablet with a FREE downloadable 2D barcode reader app
- Text messaging service:
» Tailored to your patient’s diagnosis and medication routine to provide automated messages including dose reminders or missed dose alerts
» Triggers an electronic record of missed (or recorded) doses back to the provider (optional/customizable)
» Alerts and reminders can also be sent to a family member or other care provider
- Up to date online resources:
» Medication information includes pill images and interactions
» Pertinent educational resources for patients and providers
» Nationally recognized drug database includes 95K drug entries
- Automatic record of patient’s medication taking history at their fingertips
RxHomeMed™ for Outpatient can be used for a variety of outpatient patient drug needs in addition to oral chemotherapy such as: insulin dose monitoring, antiretroviral therapy adherence in HIV patients, adherence to asthma treatments. It can be used for virtually any patient who has a complex medication regimen or is in need of close monitoring for medication adherence.
Pharmacists are in a unique position to take the lead in partnering with patients to significantly improve medication adherence. The ubiquity of mobile devices and self-administered oral chemotherapy is steadily on the rise. Utilizing mobile technology as part of a comprehensive health strategy provides an increased opportunity to bridge the communication gap between patients and healthcare providers. It also provides the added benefits of increasing medication adherence, reducing the strain on healthcare resources and staff, engaging users, and increasing patient autonomy.
Please contact me if you would like more information about RxHomeMed™ for Outpatient. I would be happy to answer any questions you may have or schedule a live demo.
Debra Lillington, MSN RN
Vice President Client Solutions
1–888-RxTLKIT x702 (798‑5548)