Abstract
Purpose
This project aimed to identify common drug-related problems (DRP) among elderly cancer patients, to determine the effectiveness of medication therapy management (MTM) service in resolving DRP, to determine the clinical significance of pharmacist interventions, and to determine patients’ satisfaction level of MTM service.
Method
Elderly cancer patients (age ≥65) who were at least on one chronic medication would be eligible for the MTM service. Any DRP that was detected would be recorded and steps to resolve it were taken. Pre- and post-service patient satisfaction surveys (PSS) were conducted before and after MTM. All interventions performed by MTM pharmacists were subjected to independent evaluation by a panel of three judges.
Results
One hundred eighteen patients received at least one session of MTM. We identified and attempted to resolve 361 DRPs, and the most common DRPs were drug interactions (117 cases, 32.4 %), adverse effects (114 cases, 31.6 %), and non-adherence (48 cases, 13.3 %). Forty-four interventions were performed by pharmacists and forty cases (91 %) were accepted by physicians. Almost two third of these interventions were deemed significant (or higher) by the judges. Seventy-two patients completed PSS. There was statistically significant improvement in patients’ satisfaction level after the service was provided.
Conclusion
MTM is an important platform in identifying and managing DRPs. Patients are generally satisfied with MTM services.
Similar content being viewed by others
References
American Pharmacist Association (APhA). (2004) Medication therapy management services definition and program criteria Jul 2004. Available at http://www.aacp.org/resources/historicaldocuments/Documents/MTMServicesDefinitionandProgramCriteria04.pdf. Assessed 05 October 2011
American College of Clinical Pharmacy Position Statement (2004) Medication therapy management services definition and program criteria. Available at http://www.accp.com/docs/positions/positionStatements/pos032_200407.pdf. Assessed 24 October 2011
Oliveira DR, Brummel AR, Miller DB (2007) Medication therapy management: 10 years of experience in a large integrated health care system. J Manag Care Pharm 16(3):185–195
Welch E, Delate T, Chester EA, Stubbings T (2009) Assessment of the impact of medication therapy management delivered to home-based Medicare beneficiaries. Ann Pharmacother 43:603–610
http://www.un.org/esa/population/publications/worldageing19502050. Assessed 19 September 2011
Smith BD, Smith GL, Hortobagyi GN, Buchholz TA (2009) Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol 27(17):2758–2765
Population Reference Bureau (2010) Today’s research on aging. July. No. 20. http://www.prb.org/pdf10/TodaysResearchAging20.pdf. Assessed 16 September 2011
http://www.mcys.gov.sg/successful_ageing/Report.html. Accessed 22 November 2009
Hajjar ER, Cafiero AC, Hanlon JT (2007) Polypharmacy in elderly patients. Am J Geriatr Pharmacother 5(4):345–351
Terret C (2005) Geriatric oncology—a challenge for the future. Eur Oncol Rev 24–26
Wedding U, Pientka L, Hoffken K (2007) Quality of life in elderly patients with cancer: a short review. Eur J Cancer 43:2203
http://www.moh.gov.sg/mohcorp/statistics.aspx?id=5526. Assessed 22 November 2009
Extermann M, Hurria A (2007) Comprehensive geriatric assessment for older patients with cancer. J Clin Oncol 25(14):1824–1831
Poon D (2008) Challenges in the practice of geriatric oncology in a national comprehensive cancer centre in Asia. Asia-Pac Oncol Haematol 1:67–68
American Society of Hospital Pharmacists (1993) ASHP statement on pharmaceutical care. Am J Hosp Pharm 50:1720–1723
Hanlon JT, Lindblad CIL, Hajjar ER, McCarthy TC (2003) Update on drug-related problems in the elderly. Am J Geriatr Pharmacother 1(1):38–43
Goldberg RM, Tabah-Fisch I, Bleiberg H et al (2006) Pooled analysis of safety and efficacy of oxaliplatin plus fluorouracil/leucovorin administered bimonthly in elderly cancer patients with colorectal cancer. J Clin Oncol 24(25):4085–4091
Litchman SM, Hollis D, Antonius A et al (2006) Prospective evaluation of the relationship of patient age and paclitaxel clinical pharmacology: cancer and leukemia group B (CALGB 9762). J Clin Oncol 24(12):1846–1851
Wedding U, Honecker F, Bokemeyer C, Pientka L, Hoffken K (2007) Tolerance to chemotherapy in elderly patients with cancer. Cancer Control 14(1):44–56
Litchman SM, Buchholtz M, Marino J et al (1992) Use of cisplatin for elderly patients. Age Ageing 21:202–204
Smorenburg CH, ten Tije AJ, Bontenbal M et al (2003) Altered clearance of unbound paclitaxel in elderly patients with metastatic breast cancer. Eur J Cancer 39:196–202
Albert J, Ten T, Verweij J, Carducci MA et al (2005) Prospective evaluation of the pharmacokinetics and toxicity profile of docetaxel in the elderly. J Clin Oncol 23(6):1070–1077
Hurria A, Togawa K, Mohile SG et al (2011) Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol 29(25):3457–3465
Extermann M, Boler I, Reich R et al (2010) The Chemotherapy Risk Assessment Scale for High-age patients (CRASH) score: design and validation. J Clin Oncol 28:15s, suppl; abstract 9000
Rhoads M, Thai A (2003) Physician acceptance rate of pharmacist recommendations to reduce use of potentially inappropriate medications in the assisted living setting. Consult Pharm 18(3):241–247
Von Muenster SJ, Carter BL, Weber CA, Ernst ME, Milchak JL, Steffensmeier JJ, Xu Y (2008) Description of pharmacist interventions during physician–pharmacist co-management of hypertension. Pharm World Sci 30(1):128–135
Doucette WR, McDonough RP, Klepser D, McCarthy R (2005) Comprehensive medication therapy management: identifying and resolving drug-related issues in a community pharmacy. Clin Ther 27(7):1104–1111
McCollum M, Nuffer W, Ellis SL, Turner CJ (2009) Physician acceptance of pharmacotherapy recommendations made by pharmacy students in a rural pharmacy-based diabetes care and education clinic. Am J Pharm Educ 73(2):24
Lundquist LM, Moye PM (2009) Resident physicians’ acceptance of pharmacy students’ pharmacotherapy recommendations during an ambulatory care advanced pharmacy practice experience. Am J Pharm Educ 73(8):145
Wilson S, Wahler R, Brown J, Doloresco F, Monte SV (2011) Impact of pharmacist intervention on clinical outcomes in the palliative care setting. Am J Hosp Palliat Med 28(5):316–320
Chumney EC, Robinson LC (2006) The effects of pharmacist interventions on patients with polypharmacy. Pharm Pract 4(3):103–109
Shah S, Dowell J, Greene S et al (2006) Evaluation of clinical pharmacy services in a haematology/oncology outpatient setting. Ann Pharmacother 40:1527–1533
Kjeldsen LJ, Jensen TB, Jensen JJ et al (2011) Physicians’ evaluation of clinical pharmacy revealed increased focus on quality improvement and cost savings. Dan Med Bull 58(5):A4261
Alsoud NA, El-Hamamsy M, Zawahry HA, Al-Azizi M (2010) Effects of clinical pharmacist interventions on clinical outcomes in oncology patients. Res J Med Med Sci 5(2):133–141
Ganachari MS, Mahendra Kumar BJ, Shashikala CW, Fibin M (2010) Assessment of drug therapy interventions by clinical pharmacist in a tertiary care hospital. Indian J Pharm Pract 3(3):22–28
Knez L, Laaksonen R, Duggan C et al (2010) Evaluation of clinical interventions made by pharmacists in chemotherapy preparation. Radiol Oncol 44(4):249–256
Barnett MJ, Frank J, Wehring H et al (2009) Analysis of pharmacist provided medication therapy management (MTM) services in community pharmacies over 7 years. J Manag Care Pharm 15(1):18–31
McMahan R (2008) Operationalizing MTM through the use of health information technology. J Manag Care Pharm 14(2 Suppl):S18–S21
Conflict of interest
The authors of this manuscript have full control of all primary data and we are agreeable to allowing the journal to review our data if requested.
Funding
This study was done with funding from the Healthcare Quality Improvement Funding, Ministry of Health, Singapore.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Yeoh, T.T., Si, P. & Chew, L. The impact of medication therapy management in older oncology patients. Support Care Cancer 21, 1287–1293 (2013). https://doi.org/10.1007/s00520-012-1661-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00520-012-1661-y