Collaborative Physician-Pharmacist Clinic Decreases Polypharmacy and Prevents Treatment Delays in Multiple Myeloma

Multidisciplinary care achieved by incorporating another sub-specialized provider increased adherence to core supportive care measures and reduced delays in acquiring oral immunomodulatory agents for patients with multiple myeloma, according to data presented at the 60th ASH Annual Meeting and Exposition.

Researchers led by Karen Sweiss, PharmD, of the University of Illinois Cancer Center and the Department of Pharmacy Practice at the University of Illinois at Chicago, tested a collaborative model that included an oncology pharmacist who provided consultation on all patients in a specialist myeloma clinic.

The pharmacist reviewed medications, provided medications lists, confirmed that physicians were adhering to supportive care guidelines, discussed treatment-related side effects, and assisted with access to oral specialty medications. The researchers compared results between (a) a group of patients seen in the new model and (b) a group of patients treated by the same physician the previous year who received ad hoc pharmacy consultation under the older clinic model.

According to the study abstract, the new model led to significant improvements in adherence to supportive medications including bisphosphonates (P=.0002), calcium and vitamin D (P<.001), acyclovir (P=.0009), and Pneumocystis jirovecii pneumonia [PJP] prophylaxis (P<.0001). In addition, the collaborative clinic greatly shortened the time to initiation of bisphosphonates (5.5 vs. 97.5 days; P<.001)and PJP prophylaxis (11 vs. 40.5 days; P<.001) after autologous transplantation. Furthermore, the new model significantly reduced delays in immunomodulatory treatment.

Polypharmacy rates were high in both groups, but the clinic was successful in reducing both minor polypharmacy (five to nine medications) and major polypharmacy (10 or more medications), the researchers wrote. The new group of patients took fewer medications on average; the median number of myeloma-related medications was higher, but the number of non-myeloma-related medications was lower.

The authors said their collaborative model may be applied to other complex diseases and encouraged similar studies in other cancer clinics, in addition to examinations of the long-term impact of the model.