Veterans on anticancer medications in rural and community environment support (VA CARES) program: A pharmacist-led telemedicine medication management program for veterans receiving oral antineoplastic therapies through the MISSION Act.

Authors

null

Regan Healy

George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT

Regan Healy , Deborah Passey , Derek Pinnell , Joshua Qualls , Clayton Hamilton , Zach Burningham , Elizabeth Tilley , Tanya Hood , Brian C Sauer , Ahmad Sami Halwani

Organizations

George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, University of Utah, Salt Lake City, UT, George E. Wahlen Department of Veterans Affairs Medical Center, Utah USA, Salt Lake City, UT, Department of Veterans Affairs, Salt Lake City, UT, George E. Wahlen Veterans Administration Medical Center, Salt Lake City, UT, University of Utah Hospital, Salt Lake City, UT, Veteran Affairs Rocky Mountain Network (VISN 19), Cheyenne, WY, University Utah, Division of Epidemiology, SLC VA IDEAS Center, Salt Lake City, UT

Research Funding

Other Government Agency
U.S. Dept. of Veterans Affairs, Health Services Research and Development Service (RVR 19-483)

Background: Cancer therapies are leveraging oral targeted treatments over traditional cytotoxic chemotherapy (CT) at an increasing rate. Compared to CT, use of oral antineoplastic treatments (OATs) shift some of the burden of medication management onto patients. To address these challenges, several health systems have developed multidisciplinary OAT management teams or ‘clinics’ whereby an Oncology Clinical Pharmacist (OCP) collaborates with oncology teams to ensure optimal use of these agents. Through the VA MISSION Act of 2018, Veterans can be prescribed treatments in the community which are dispensed by VA. These Veterans often live in rural areas and may lack access to comprehensive medication management resources. Methods: The VA CARES Program is a telemedicine medication management ‘clinic’ and care delivery model for patients receiving OATs leveraging custom designed health information technology (HIT) tools to remotely coordinate OAT related care. Veterans are automatically enrolled in the program if they have OATs prescribed by community providers which are to be dispensed by VA. An OCP provides telemedicine medication management services. The OCP performs a screening assessment, ensures appropriate indication and dosing, reviews baseline laboratory results, and performs a thorough drug-drug interaction analysis. The OCP then provides OAT education. Throughout the duration of therapy the OCP ensures necessary therapeutic monitoring, and regularly follows up with the Veterans. Subsequent encounters are to assess knowledge, adherence, toxicities, new drug-drug interactions, and need for OAT refills. The outcome measures for the VA CARES Program include safety (number and type of pharmacist interventions), economic benefits (cost savings or cost avoidance), and patient satisfaction. Results: In the initial 13 months, the VA CARES Program screened N = 78 and enrolled N = 64 (82%) Veterans from three VA medical facilities in VISN-19 from January 2020 to January 2021. The CPS performed n = 342 telemedicine visits and n = 80 interventions leading to improved safety, effectiveness, and/or an economical benefit. The most common interventions included detection and/or prevention of drug-drug interactions (n = 45) and adverse events (n = 18), drug not indicated (n = 13), alternative therapy suggested (n = 7), and limited-quantity dispensed (n = 7). The CPS interventions saved an estimated $210,864 in medication-related costs or avoidance. The Veterans surveyed were highly satisfied with the program services. Conclusions: Telemedicine delivery of oncology medication management by an OCP across systems is feasible, and provides clinical and economic benefits.

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Abstract Details

Meeting

2021 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Care Delivery and Regulatory Policy

Track

Care Delivery and Quality Care

Sub Track

Care Delivery

Citation

J Clin Oncol 39, 2021 (suppl 15; abstr 1545)

DOI

10.1200/JCO.2021.39.15_suppl.1545

Abstract #

1545

Poster Bd #

Online Only

Abstract Disclosures