Chronic Lymphocytic Leukemia, Chronic Myeloid Leukemia, Multiple Chronic Conditions
Conditions
Brief summary
The objective of this study is to improve medication, symptom, and disease management of patients with hematological malignancies and multiple chronic conditions (2 or more conditions in addition to cancer) through care coordination between pharmacists working in oncology practices and those working in primary care practices (Pharmacists Coordinated care Oncology Model \[PCOM\]). This is a pilot study in which the investigators will examine the association between outcome measures, but the study design and sample size are insufficient to quantify the impact of OAA initiation or OAA adherence on adherence to chronic medications. This pilot study and data analyses are being done in preparation for a larger, controlled study.
Interventions
OTHERPatient Reported Outcome Measure (PROM)
Participants will complete a PROM (Michigan Oncology Quality Consortium, Patient Assessment Tool for Oral Chemotherapy) for their oral anticancer agent (OAA) at two timepoints over 2 months, to assess patient symptoms and adherence to OAA.
OTHERComprehensive Medication Review (CMR)
Following the first PROM, participants will be contacted by the primary care pharmacist for a Comprehensive Medication Review (CMR) for their chronic medications. If warranted, a follow-up CMR will take place after the second PROM.
OTHERCommunications between oncology and primary care pharmacists
Throughout the study, the oncology and primary care pharmacists will communicate about medications through the electronic medical record.
Sponsors
AstraZeneca
University of Michigan Rogel Cancer Center
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Has primary care physician * Diagnosis of chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL), chronic myeloid leukemia (CML), or multiple myeloma (MM) * Initiating an OAA, either for the first time or a change from previous OAA * Diagnosis of at least 2 chronic conditions, including at least one of the following: diabetes, hypertension, hyperlipidemia, congestive heart failure, depression/anxiety, gastroesophageal reflux disease, and/or chronic obstructive pulmonary disease * Patients taking at least two chronic medications, including at least one medication for one of the conditions listed above. * Willing and able to sign informed consent.
Exclusion criteria
* Cannot speak English * Concurrent diagnosis of type 1 diabetes * Concurrent diagnosis of human immunodeficiency virus
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Dose-adjusted proportion of days covered (PDC) for oral anti-cancer agent (OAA) | Up to 6 months following OAA initiation | PDC is a common way to assess a patient's adherence to a medication regimen. PDC is the ratio of number of days the patient is supplied with OAA medication, from the time of OAA initiation until 6 months later, to the total number of days during that period. For OAAs, data from the electronic medical record (EMR) for dose changes will be aligned with the refill data to calculate a dose-adjusted PDC. |
| PDC for chronic condition medications | Up to 6 months following OAA initiation | PDC is the ratio of the number of days the patient is supplied with chronic condition medications, from the time of OAA initiation until 6 months later, to the total number of days during that period. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percent of patients with scheduled Comprehensive Medication Review (CMR) within one week of first PROM result | Day 22 (+/-3) after OAA initiation | The PROM is scored within one day after it is completed by the patient. The primary care pharmacist sets a date and time for the initial CMR after receiving the first scored PROM. |
| Percent of patients where oncology pharmacist reviewed PROM within 1 day of receiving scored PROM | Up to day 44 (+/-3) after OAA initiation | The PROM is scored within one day after it is completed by the patient and is routed to the oncology pharmacist to review the results. The number of PROMs that are reviewed within 1 day of receipt will be assessed at 2 weeks and at 6 weeks. |
| Percent of patients with two completed Patient Reported Outcome Measures (PROMs) | Up to day 42 (+/-3) after OAA initiation | The Michigan Oncology Quality Consortium (MOQC) OAA PROM, Patient Assessment Tool for Oral Chemotherapy is to be completed at 2 and 6 weeks after OAA initiation. This measure assesses the percent of patients who complete this PROM at both time points. |
| Percent of CMR notes that oncology pharmacist reviewed | Up to day 44 (+/-3) after OAA initiation | The number of CMR notes reviewed by the oncology pharmacist out of the total number of completed CMRs, assessed at 2 weeks and at 6 weeks. |
| Percent of CMRs where note was routed to oncology pharmacist | Up to day 43 (+/-3) after OAA initiation | The number of CMR where note was routed to oncology pharmacist out of total number of completed CMRs, assessed at 2 weeks and at 6 weeks. |
| Percent of patients with completed Comprehensive Medication Reviews (CMRs) | Day 50 (+/-3) after OAA initiation | Completed CMR includes initial and follow-up CMR with primary care pharmacist. |
Countries
United States
Outcome results
None listed