Evaluation and clinical impact of a pharmacist-led, interdisciplinary service focusing on education, monitoring and toxicity management of immune checkpoint inhibitors.

INTRODUCTION: Immune-related adverse events are complications of immune checkpoint inhibitors which require robust patient education and proactive follow-up to ensure timely identification and management. Oncology pharmacist practice models with other anticancer modalities have been well documented, but there is limited evidence assessing the spectrum of pharmacist interventions in patients receiving immune checkpoint inhibitor(s) and the impact of these interventions on patient outcomes. METHODS: Patients initiated on immune checkpoint inhibitor(s) from 1 January 2016 to 31 August 2019 were included for data collection and analysis. Part 1 featured an intensive pharmacist follow-up cohort (study cohort) and summarized pharmacist interventions. Part 2 compared patient outcomes between the study cohort and a standard of care cohort (control cohort) from a different oncology centre. Patient outcomes included emergency department visits not resulting in admission, hospitalizations due to immune-related adverse event(s), immune checkpoint inhibitor cycles received, treatment discontinuation due to immune-related adverse event(s), completion of finite programmed death-1/death-1 ligand treatment course and completion of ipilimumab. Clinical outcomes were compared using a retrospective, matched cohort design based on age, cancer diagnosis and immune checkpoint inhibitor(s). RESULTS: A total of 143 patients were included in Part 1 encompassing 1664 pharmacist recommendations across 11 categories. The matched cohort yielded 92 matches (n = 184) with a higher odds of immune checkpoint inhibitor discontinuation due to immune-related adverse event(s) in the control cohort (odds ratio (OR) (95% confidence interval (CI)) = 5.5 (1.2-24.8); p = 0.022). CONCLUSION: Intensive immune-related adverse event education, proactive follow-up and immune-related adverse event management by pharmacists result in clinically meaningful interventions which correlate to improved patient outcomes, namely lower odds of treatment discontinuation due to immune-related adverse event(s).

Older Adults' Use of and Interest in Technology and Applications for Health Management: A Survey Study.

Background: Older adults face challenges with managing their medications, obtaining health education, and accessing health services. Mobile health (mHealth), defined as any medical or public health practice facilitated through mobile devices, could help to overcome these difficulties. Objectives: To determine what technologies and apps are in current use by older adults, to explore the types of technologies and apps that may be of interest to people in this age group, to explore concerns about technologies, and to examine any age-related differences. Methods: Adults 60 years of age or older were invited to complete a 35-item electronic survey, in either French or English, which was distributed through social media and by email from organizations working with older adults. The survey was conducted in mid-2020. Results: A total of 266 respondents completed some or all of the survey. Most participants had a mobile phone (229/243, 94.2%), and approximately one-third (78/222, 35.1%) had used a health-related app in the previous 12 months; this level of usage was consistent across age groups. Most respondents were interested in using an app to improve their health (171/225, 76.0%), with variation by age: highest among those 60-64 years of age (82/95, 86.3%), lower among those 80 years or older (40/52, 76.9%), and lowest among those 65-69 years of age (6/14, 42.9%). Most older adults were interested in using an app to ask questions of pharmacists (161/219, 73.5%) and to review their medications (154/218, 70.6%). Participants' mHealth concerns focused on costs, disclosure of personal information, effectiveness, usability, and endorsement by health care providers. The study limitations included challenges related to electronic recruitment and survey distribution, as well as a high representation of participants with postsecondary education. Conclusions: These findings suggest that a substantial proportion of older adults are already using and are interested in using mHealth for health information, to ask questions, and/or to review their medications with a health care team member.

Contexte: Les personnes âgées sont confrontées à des difficultés pour gérer leurs médicaments, s'informer sur la santé et accéder aux services de santé. Les applications de « santé mobile ¼, définies comme toute pratique médicale ou de santé publique facilitée par des appareils mobiles, pourraient aider à surmonter ces difficultés. Objectifs: Déterminer quelles technologies et applications sont actuellement utilisées par les aînés; examiner celles qui pourraient être intéressantes dans cette tranche d'âge; étudier les préoccupations concernant les technologies et examiner les différences liées à l'âge. Méthodes: Des adultes d'au moins 60 ans ont été invités à répondre à un sondage électronique comprenant 35 questions en français ou en anglais. Ce sondage, mené à la mi-2020, a été diffusé par des organismes travaillant avec des aînés via les médias sociaux et par courriel. Résultats: Au total, 266 participants y ont répondu en partie ou en totalité. La plupart des répondants avaient un téléphone portable (229/243, 94,2 %) et environ un tiers (78/222, 35,1 %) avaient utilisé une application liée à la santé au cours des 12 derniers mois; ce taux d'utilisation était constant tous groupes d'âge confondus. La plupart des répondants souhaitaient utiliser une application pour améliorer leur santé (171/225, 76,0 %), avec des variations du taux d'utilisation selon l'âge : le plus élevé chez les 60 à 64 ans (82/95, 86,3 %), un peu moins chez les 80 ans ou plus (40/52, 76,9 %), et le plus bas chez les 65 à 69 ans (6/14, 42,9 %). La plupart des personnes âgées souhaitent utiliser une application pour poser des questions aux pharmaciens (161/219, 73,5 %) et pour s'informer sur leurs médicaments (154/218, 70,6 %). Les préoccupations des participants en matière de « santé mobile ¼ portaient sur les coûts, la divulgation d'informations personnelles, l'efficacité, la convivialité et l'approbation par les prestataires de soins de santé. On notera, parmi les limites de l'étude, les défis liés au recrutement électronique et à la distribution électronique des sondages, ainsi qu'une forte représentation de participants ayant fait des études postsecondaires. Conclusions: Ces résultats portent à croire qu'une proportion importante d'adultes âgés utilisent déjà la technologie de « santé mobile ¼ et souhaitent l'utiliser pour obtenir des informations sur la santé, poser des questions et/ou s'informer sur leurs médicaments auprès d'un membre de l'équipe de soins de santé.