Evaluation and Implementation of Pharmacy Services in a Unique Hematopoietic Stem Cell Transplant Clinic

Background: The evaluation and implementation of tailored outpatient pharmacy services for patients undergoing hematopoietic stem cell transplantation (HCT) in a unique outpatient clinic of a comprehensive cancer center are described. Summary: Supportive medications used in HCT are crucial in preventing HCT-related complications. High prescription costs and complex medication regimens contribute to decreased medication adherence. In this center, the majority of HCTs are performed completely outpatient and oral medications must be obtained from an outpatient pharmacy. Outpatient medication dispensing is a pivotal process to ensure medication access and adherence. Retrospective chart analysis and patient surveys were conducted to assess unmet outpatient pharmacy needs of this population, which included medication insurance assistance, delivery, and education. An outpatient pharmacy services algorithm was developed and implemented to prioritize those needs through the community pharmacy at the cancer center. The key components of the algorithm included early planning for prescriptions, incorporation of pharmacy topics into patient education prior to HCT, dedication of a pharmacy technician for medication delivery to clinic, incorporation of an existing prescription assistance team to assist with high cost medications, and use of student pharmacists to provide patient education on immunosuppression and prophylactic antimicrobials. Post-implementation evaluations of this workflow showed zero medication delays and a prescription cost saving of $40,000 in one month for patients through the prescription assistance team. Conclusion: Systematic evaluation, design, implementation, and re-evaluations of pharmacy services were successfully conducted and implemented for a unique outpatient HCT patient population. Community pharmacy services at a cancer center can help improve patient care and reduce the high financial burden of cancer treatment.