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.

Patient assistance programs: a valuable, yet imperfect, way to ease the financial toxicity of cancer care.

High out-of-pocket (OOP) spending on cancer drugs is a known contributor to "financial toxicity" among cancer patients. Many predict that this problem will only worsen as patients continue to bear more responsibility for the cost of their medical care and as the use of oral chemotherapeutic agents increases. Although foundations and pharmaceutical companies offer patient assistance programs (PAPs) to improve drug affordability, the degree to which these programs are used is poorly understood. There are several barriers to the use of PAPs that not only affect access to patients who may benefit but also create limitations on the research and study of these programs.

Validation of Venous Clinical Severity Score (VCSS) with other venous severity assessment tools from the American Venous Forum, National Venous Screening Program.

BACKGROUND: Several standard venous assessment tools have been used as independent determinants of venous disease severity, but correlation between these instruments as a global venous screening tool has not been tested. The scope of this study is to assess the validity of Venous Clinical Severity Scoring (VCSS) and its integration with other venous assessment tools as a global venous screening instrument. METHODS: The American Venous Forum (AVF), National Venous Screening Program (NVSP) data registry from 2007 to 2009 was queried for participants with complete datasets, including CEAP clinical staging, VCSS, modified Chronic Venous Insufficiency Quality of Life (CIVIQ) assessment, and venous ultrasound results. Statistical correlation trends were analyzed using Spearman's rank coefficient as related to VCSS. RESULTS: Five thousand eight hundred fourteen limbs in 2,907 participants were screened and included CEAP clinical stage C0: 26%; C1: 33%; C2: 24%; C3: 9%; C4: 7%; C5: 0.5%; C6: 0.2% (mean, 1.41 ± 1.22). VCSS mean score distribution (range, 0-3) for the entire cohort included: pain 1.01 ± 0.80, varicose veins 0.61 ± 0.84, edema 0.61 ± 0.81, pigmentation 0.15 ± 0.47, inflammation 0.07 ± 0.33, induration 0.04 ± 0.27, ulcer number 0.004 ± 0.081, ulcer size 0.007 ± 0.112, ulcer duration 0.007 ± 0.134, and compression 0.30 ± 0.81. Overall correlation between CEAP and VCSS was moderately strong (r(s) = 0.49; P < .0001), with highest correlation for attributes reflecting more advanced disease, including varicose vein (r(s) = 0.51; P < .0001), pigmentation (r(s) = 0.39; P < .0001), inflammation (r(s) = 0.28; P < .0001), induration (r(s) = 0.22; P < .0001), and edema (r(s) = 0.21; P < .0001). Based on the modified CIVIQ assessment, overall mean score for each general category included: Quality of Life (QoL)-Pain 6.04 ± 3.12 (range, 3-15), QoL-Functional 9.90 ± 5.32 (range, 5-25), and QoL-Social 5.41 ± 3.09 (range, 3-15). Overall correlation between CIVIQ and VCSS was moderately strong (r(s) = 0.43; P < .0001), with the highest correlation noted for pain (r(s) = 0.55; P < .0001) and edema (r(s) = 0.30; P < .0001). Based on screening venous ultrasound results, 38.1% of limbs had reflux and 1.5% obstruction in the femoral, saphenous, or popliteal vein segments. Correlation between overall venous ultrasound findings (reflux + obstruction) and VCSS was slightly positive (r(s) = 0.23; P < .0001) but was highest for varicose vein (r(s) = 0.32; P < .0001) and showed no correlation to swelling (r(s) = 0.06; P < .0001) and pain (r(s) = 0.003; P = .7947). CONCLUSIONS: While there is correlation between VCSS, CEAP, modified CIVIQ, and venous ultrasound findings, subgroup analysis indicates that this correlation is driven by different components of VCSS compared with the other venous assessment tools. This observation may reflect that VCSS has more global application in determining overall severity of venous disease, while at the same time highlighting the strengths of the other venous assessment tools.