An Oncology Perspective on Issues With Seamless Pharmaceutical Care

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An Oncology Perspective on Issues With Seamless
Pharmaceutical Care

• Presented by
• Vicki MacGarvie
• MHSA Candidate
• April 4, 2002

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Overview

• Research Objective
• Methodology
• Facts Terminology
• Stages of Care Issues and Seamless Care
  Initiatives
• Recommendations

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Research Objective

• To determine the issues with the delivery of
  cancer care across the continuum of care in Nova
  Scotia and some other provinces.
• To identify problem areas specific to the
  delivery of seamless pharmaceutical care in
  oncology patients.
• To recommend strategies for improvements in the
  delivery of seamless care in oncology patients.

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Background

• Incidence of cancer is increasing in Canada
• Drugs to treat cancer are expensive coverage of
  these drugs by public payers differs widely
  across provinces
• Advances in medicine are allowing patients to be
  administered more oncology-related medications
  outside the inpatient setting.
• There appears to be some evidence that many
  cancer patients experience difficulties with the
  lack of seamless care

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Seamless Care Defined

• seamless care is the desirable continuity of
  care delivered to a patient in the health care
  system across the spectrum of caregivers and
  their environments. Pharmacy care is carried
  without interruption such that when one
  pharmacist ceases to be responsible for the
  patients care, another pharmacist or healthcare
  professional accepts responsibility for the
  patients care (Canadian Society of Hospital
  Pharmacists/Canadian Pharmacists Associations
  Seamless Care Workshop)

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Methodology

• Literature Review issues with seamless care in
  general and specifically in oncology care
• Investigated several issues with oral oncology
  drugs approved in 2000 and 2001 Timeliness for
  inclusion on provincial formularies, differences
  between provinces in coverage, etc.
• Conducted personal discussions with various
  cancer care providers

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Results
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Common Barrier to Achieving Seamless Care

• Time
• Resources
• Education
• Communication
• Patient Confidentiality

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Example Following a typical cancer patient
through the continuum of care and reviewing the
problems they experience
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Patient DiagnosisPatient AdmissionPatient
DischargeSupport Palliative Care
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Patient DiagnosisPatient AdmissionPatient
DischargeSupport Palliative Care
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Patient Diagnosis

• Transportation for diagnostic procedures
• Wait times for diagnostic procedures
• Patient Uncertainty
• Patient Anxiety - what costs will be covered by
  insurance plan

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Seamless Initiatives

• Canadian Cancer Society Transportation Program
• Breast Link Program
• Patient Navigator Program
• In-patient and out-patient social workers

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Patient DiagnosisPatient AdmissionPatient
DischargeSupport Palliative Care
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Patient Admission

• All drug costs are covered under the Canada
  Health Act
• Multidisciplinary team-work improves patient care
  and patient knowledge.
• Patient may lose employment time

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Seamless Initiatives

• Multi-disciplinary teamwork
• Communication between care providers and patient
• People there to help transition the patient back
  into the home or community. Patient Navigator.

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Patient DiagnosisPatient AdmissionPatient
DischargeSupport Palliative Care
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Patient Discharge

• Rely on family physician and community pharmacist
• Home Care is inconsistently provided across the
  province
• Programs to help patient afford drugs varies
  across the province

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Seamless Initiatives

• Tele-homecare projects in rural areas. Costly to
  implement.
• Patient Discharge Summaries
• Out-of-Province Nurse Liaison
• NOINS

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Patient DiagnosisPatient AdmissionPatient
DischargeSupport Palliative Care
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Supportive Palliative Care

• Pain medications can be costly
• Palliative Care in hospital versus at home
• Pain management education to family doctor and
  community pharmacist

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Seamless Initiatives

• Palliative Care Program (QEII in-patient and
  out-patient palliative care nurses)
• Home Care

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Discussion Recommendations
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Recommendation 1

• Improve and encourage communication between GP,
  specialist, hospital pharmacist, and community
  pharmacist
• Develop a task group that includes all key
  stakeholders to develop innovative ways (I.e.
  patient passports) to improve these
  communications and learn what information must be
  shared. Patient confidentiality must be a
  priority.

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Recommendation 2

• Educate community pharmacists and family
  physicians on what to expect from cancer patients
  returning from treatment
• Information resource line or intranet
• Education booklets and/or reference materials

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Recommendation 3

• Share innovative programs that have worked in
  other areas to improve seamless care.
• The Breast Cancer Link Program
• Multi-disciplinary teamwork in the community

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Recommendation 4

• Review the benefits and disadvantages to current
  eligibility to provincial formularies and drug
  listing.
• Improve Timeliness of coverage of new therapies
• Improve aid to those financially constrained
  (Should the income level consider family size?)

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Questions??

• Thank you for your time!!