Pilot study evaluating feasibility and utility of pharmacist-driven oral antineoplastic agent monitoring program.

INTRODUCTION: Oncologists are increasingly prescribing oral antineoplastic agents which have benefits and challenges impacting patient outcomes. Practice guidelines recommend monitoring symptoms and adherence without outlining any specific tools or methods for monitoring. Pharmacists are successful in monitoring patients on therapy and improving outcomes. We aimed to assess the feasibility and utility of a pharmacist-delivered and medical record-integrated adherence and symptom monitoring program for patients on oral antineoplastic agents. METHODS: This single-center, prospective, interventional study designed and implemented an adherence and monitoring program. A pharmacist contacted patients twice between clinic visits for three months. During telephone encounters, patients were verbally screened for medication adherence and assessed for new or changing symptoms using the Edmonton Symptom Assessment System as a signal of possible adverse events. We measured feasibility via patient enrollment, completed proportion of scheduled contacts, and pharmacist time. Utility was assessed through patient adherence, satisfaction surveys, healthcare resource utilization, and pharmacist interventions (i.e., patient education, adherence assistance, and symptom management). RESULTS: Fifty-one patients participated. Ninety-one percent of scheduled patient contacts were completed. Edmonton Symptom Assessment System was administered by pharmacy personnel 102 times. Patient-reported adherence was 100%. Overall satisfaction was 85% and 100%, for patients and physicians, respectively. Fifty-one (98%) pharmacist recommendations were accepted. There were 14 total utilizations of healthcare resources-5.2 per 1000 patient days. CONCLUSIONS: This study suggests a pharmacist monitoring program for patients taking oral antineoplastic agents is feasible and provides utility. Further research is needed to evaluate whether this program improves safety, adherence, and outcomes in patients using oral antineoplastic agents.

Use of high-fidelity simulation to teach end-of-life care to pharmacy students in an interdisciplinary course.

OBJECTIVE: To assess the effect of high-fidelity simulation on pharmacy students' attitudes and perceived competencies in providing end-of-life care in an interdisciplinary palliative care course. DESIGN: Thirty pharmacy students participated in a high-fidelity simulation of the 15 minutes before and 15 minutes after the death of a patient with end-stage renal disease. ASSESSMENT: Students completed the Attitudes Toward Death Survey and the End of Life Competency Survey prior to and after experiencing the simulation. A reflections journal exercise was used to capture post-simulation subjective reactions, and a course evaluation was used to assess students' satisfaction with the simulation experience. Students' post-simulation attitudes toward death significantly improved compared to pre-simulation attitudes and they felt significantly more competent to take care of dying patients. Students were satisfied with this teaching method. CONCLUSION: High-fidelity simulation is an innovative way to challenge pharmacy students' attitudes and help them with knowledge acquisition about end-of-life care.

Impact of clinical pharmacy services on patients in an outpatient chemotherapy academic clinic.

BACKGROUND: Assessing the role of the pharmacist in an outpatient oncology clinic requires quantification of parameters that are important to the patient and the healthcare system. Patient evaluations not only serve as benchmarks for a process; but may also predict behavior such as utilization of care, continuity with the provider, and compliance. PURPOSE: To identify the role of the patient-pharmacist relationship and enhance patient satisfaction with care, a survey tool was developed and utilized. METHODS: A 20-item, 2-page survey tool was developed and administered to oncology patients actively receiving treatment at the Cancer Therapy & Research Center (CTRC) in San Antonio, Texas. Following approval from the Investigational Review Board, survey distribution began on December 1, 2009 and continued through February 2010. Basic social and demographic data were collected. Satisfaction with pharmacy service was assessed with questions on a Likert ranking scale detailing time spent with pharmacists, knowledge of medication therapy, willingness to pay for clinical pharmacy services, etc. The primary outcome was the impact of the pharmacist-patient relationship assessed by examining the interaction between time spent with pharmacist, understanding of medications, and desire for future pharmacy counseling services. RESULTS: A total of 77 surveys were administered and collected. Of the patients surveyed, 86% stated that it is important for patients to discuss their treatment with a pharmacist and 76% requested pharmacy follow-up at future visits. CONCLUSION: This cross-sectional survey reveals that patients are interested in visiting with a pharmacist regularly during chemotherapy treatment and patients may be willing to pay for pharmacy counseling services.

Targeted high lung concentrations of itraconazole using nebulized dispersions in a murine model.

PURPOSE: The purpose of this study was to investigate the delivery of itraconazole (ITZ) particles to a murine lung model by nebulization. METHODS: Three ITZ formulations were prepared and characterized in the dry state using contact angle, dissolution, X-ray powder diffraction, scanning electron microscopy, and Brunauer-Emmett-Teller surface area analysis. Aerodynamic particle size distributions and lung deposition studies in 14 outbred male ICR mice were performed using aqueous dispersions of all the formulations. A separate dosing uniformity study was also performed to qualify use of the chamber. RESULTS: All formulations had an aggregated particle size of approximately 30 microm in diameter. Two formulations showed that 80% of the drug dissolved in less than 5 min. The remaining ITZ formulation had a slower dissolution and the lowest total emitted dose from the nebulizer used. High concentrations of ITZ were shown to be present in the mouse lung during the lung deposition study, up to 16.8 +/- 0.13 microg/g (+/- SE) were achieved. Concentrations of up to 0.76 +/- 0.03 microg/g (+/- SE) could be maintained from the single nebulized dose for at least 24 h. CONCLUSION: An effective method of targeted delivery of ITZ to the deep lung is presented that may be useful for the treatment and prevention of acute fungal infections.

In vivo efficacy of aerosolized nanostructured itraconazole formulations for prevention of invasive pulmonary aspergillosis.

Aerosolized evaporative precipitation into aqueous solution and spray freezing into liquid nanostructured formulations of itraconazole as prophylaxis significantly improved survival relative to commercial itraconazole oral solution and the control in a murine model of invasive pulmonary aspergillosis. Aerosolized administration of nanostructured formulations also achieved high lung tissue concentrations while limiting systemic exposure.