Predicting time to medication access for hematologic malignancies: the impact of an integrated specialty pharmacy and limited distribution drug networks

IF 2.4
A. Zuckerman, Megan E. Peter, Samuel A. Starks, M. Maulis, Josh Declerq, Leena Choi, M. Jagasia
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引用次数: 0

Abstract

Abstract Background: Barriers to accessing oral oncolytic therapy include insurance authorization, high copays and limited distribution drug (LDD) networks. In September 2015, a pharmacist joined an outpatient hematology clinic to facilitate timeliness of medications (for which the pharmacy has access) dispensed by Vanderbilt Specialty Pharmacy (VSP). The scope expanded to manage non-VSP medications (LDD) in June 2016. Aims: Compare access time to oral oncolytic therapy between drugs to which VSP has access vs. non-VSP medications, and to test whether patient access time to non-VSP agents reduced after integrating a pharmacist. Methods: We reviewed medical records of adult patients prescribed oral oncolytic therapy by a hematology provider. The primary outcome was the time (in days) from treatment decision to medication shipment, stratified by drug access (VSP vs. non-VSP) and time (Time 1: September 2015–May 2016; Time 2: June 2016–September 2017). Using proportional odds logistic regression, we compared time to medication shipment between VSP and non-VSP drugs, and tested whether time to shipment decreased for non-VSP drugs from Time 1 to Time 2. Results: A total of 367 patients with 410 prescriptions were included: 285 VSP drugs and 125 non-VSP drugs. Median time from treatment decision to shipment was 6 days (IQR: 3–9) for non-VSP and 3 days (IQR: 1–6) for VSP drugs. In Time 1, time from treatment decision to shipment was significantly longer for non-VSP vs. VSP drugs (OR = 6.5, p < .001). For non-VSP drugs, time to shipment reduced from Time 1 to Time 2 (OR = −0.41, p = .04). Conclusions: Integrating a pharmacist into clinic significantly shortened time from treatment decision to shipment for non-VSP drugs. However, access to these drugs is still slower than VSP medications as they cannot be fully integrated into clinic workflow. The integrated pharmacist at VSP adds value to patient access and outperforms LDD medications, challenging the value of LDD networks beyond medical economics.
预测血液系统恶性肿瘤的用药时间:综合专科药房和有限分销药物网络的影响
摘要背景:获得口服溶瘤治疗的障碍包括保险授权、高额自付垫底费和有限分销药物(LDD)网络。2015年9月,一名药剂师加入了一家门诊血液科诊所,以促进范德比尔特专科药房(VSP)配药的及时性(药房可以获得)。2016年6月,范围扩大到管理非VSP药物(LDD)。目的:比较VSP可以获得的药物与非VSP药物之间口服溶瘤治疗的获得时间,并测试患者在整合药剂师后获得非VSP药物的时间是否减少。方法:我们回顾了血液科医生开具的成人口服溶瘤治疗的病历。主要结果是从治疗决定到药物装运的时间(以天为单位),按药物获取(VSP与非VSP)和时间进行分层(时间1:2015年9月至2016年5月;时间2:2016年6月至2017年9月)。使用比例优势逻辑回归,我们比较了VSP和非VSP药物的药物装运时间,并测试了非VSP药物从时间1到时间2的装运时间是否减少。结果:共纳入367例患者410个处方:285种VSP药物和125种非VSP药物。从治疗决定到发货的中位时间为6 天(IQR:3-9)(对于非VSP)和3 VSP药物的IQR:1-6天。在时间1中,非VSP药物从治疗决定到装运的时间明显长于VSP药物(OR=6.5,p < .001)。对于非VSP药物,发货时间从时间1减少到时间2(OR = −0.41,p = .04)。结论:将药剂师纳入临床可显著缩短非VSP药物从治疗决定到装运的时间。然而,获得这些药物的速度仍然比VSP药物慢,因为它们无法完全融入临床工作流程。VSP的综合药剂师为患者获取增加了价值,并优于LDD药物,挑战了LDD网络在医学经济学之外的价值。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Drug Assessment
Journal of Drug Assessment PHARMACOLOGY & PHARMACY-
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