Positive Quality Interventions

Fall Summit | October 18-20 | Orlando, FL

Neal Dave, PharmD, Texas Oncology; Todd Murphree, PharmD, Clearwater Cancer Institute

Positive Quality Interventions



• What is a PQI? • A patient focused intervention leading to positive

patient interactions • Supports our patients, cancer centers, and partners

• Differentiates IODs from other pharmacies

• Operationalizes and standardizes practices to achieve positive outcomes


Patient’s Needs

Strategic Partner

Clinic’s Needs

Types of PQIs

• Operational

• Ensuring adequate inventory meds

• Keeping supportive care (RX and OTC) on hand

• Financial support/ Prior Auth Process

• Follow up call schedule

Types of PQIs

• Educational

• Teaching handouts • For patients

• For staff at clinic

• Information on new drugs

• Providing proper supportive care for specific drugs

• Updates on new indications

Types of PQIs

• Clinical

• Big differentiation for IODs • Access to patient‘s chart and patient’s oncologist

• Designed for latest clinical information to be applied to patient care

• Establishes best practices even if not in the PI

FDA Approvals

• 33 Oncology Related FDA drug approvals in 2017

• Includes new approvals and/or new indications for previously approved drugs

• 14 were oral

• 3 were testing/ pathology related

The potential and need is growing for PQIs!

• Completed • Hand Foot Syndrome- Jonas Congelli, HOA CNY • Stomatitis- Matthew Schulz, Rocky Mountain CC • MCRC (Regorafenib)- Neal Dave, Texas Oncology • EGFRs- Danny Olszta, Joliet Hematology Oncology Associates • Myelofibrosis- Todd Murphree, Clearview Cancer Institute • MCRC (Trifluridine and Tipiracil)- Jen O’Doherty, Hematology

Oncology Consultants • CLL and Del17P-Danny Olszta, Joliet Hematology Oncology

Associates

• Under Review • Chemotherapy Induced Diarrhea- Joshua Nubla, NCODA • CDK4 update- Marvin Frankel Weill Cornell Solid Tumor Oncology

Practice • EGFR Follow up schedule- Chris Sellers, Texas Oncology

• Pending

• PCV- Margaret McGuinness, Compass Oncology

Interventions

Potential Opportunities • Olanzapine

• HCC

• Parps

• Instituting a Therapeutic Interchange Policy

• Testing requirements for orals • Many more coming….

Stomatitis PQI

• Stomatitis prevention in patients on Everolimus

• Swish Trial revealed prophylactic use of Dex 0.5mg/5mL reduced stomatitis

Trial All Grade 1 Grade 2 Grade 3 Grade 4

Bolero-2 67 34 25 8 0

SWISH 19.8 17.8 2.4 0 0

Hand Foot Syndrome PQI

• Using 10-20% Urea cream prophylacticly reduces severity and increases time to develop Hand Foot Syndrome typically in the first 6 weeks of treatment

• Need for pharmacies to keep in stock and to recommend to patients

• So many drugs can cause this

• Capecitabine, Infusional 5FU, TKIs…

EGFR PQI

• First line EGFR therapies in NSCLC

• Using the EMR to assess molecular targets

• Recommends Afatinib for 1st line patients with del 19 mutation (overall survival benefit shown)

• Touches on dose reductions on Afatinib do not affect PFS

MCRC Regorafenib PQI

• Used in late line MCRC

• Many dose limiting side effects • HFS, stomatitis, diarrhea, hypertension, fatigue

• Most occur within 1st 8 weeks of therapy

• Need for a proper weekly follow up schedule for the 1st 8 weeks

• REARRANGE study looking at dose induction to minimize ADRS

Publication

PQI Development Process

• What would I develop a PQI for? • Anything that can be improved by a detailed process

• A drug that requires specific monitoring

• A drug that requires a detailed process for dispensing and/or dosing

PQI Development Process • How do I write a PQI?

• Tertiary drug references

• Clinical Pharmacology

• Facts and Comparisons

• Lexi Comp

• Package insert

• Manufacturer websites/handouts

• Consolidate information into an applicable 1-3 page quick reference procedure

• Write in a way that a new pharmacist would be able to read, follow, and apply

PQI Development Process

• How hard is it? • Not rocket science

• Not creating anything new

• Simply compiling and summarizing existing information into a concise procedure format

• A great way to share and implement best practices

Newest PQIs

• Myelofibrosis

• CLL and Del17P

• www.ncoda.org/positive-quality-interventions

http://www.ncoda.org/positive-quality-interventions





Newest PQIs







Newest PQIs

• Myelofibrosis

• CLL and Del17P







Recent PQIs

PQIs – CLL and Del17P

PQIs – Managing

Myelofibrosis

PQIs - Managing Myelofibrosis

PQIs - Managing Myelofibrosis

The Future

• Need to show how PQIs are making a difference

• NCODA has teamed up a data gathering company

• Look at pilot practices to implement a PQI to see if a difference is seen from baseline • measuring quality outcomes

• patients staying on therapy longer

• minimizing ADRS

• patients avoiding hospital stays or ER visits

Next Steps

• Need member engagement

• Benefits • Become an expert/ “go-to person” for a topic (if not

already)

• Name posted on website next to PQI

• Opportunity to present PQI on monthly Webex

• Accreditation

• Can add something of measurable value to your QI program

Next Steps

• We have experts across the country that have best practices already… just need to share them

• Having different members create PQIs strengthens NCODA

• Shows that IODs are engaged in oncology care

• help with future contracts

References • 1.Lancet Oncology, Yang et. al. Jan 2015; Annals of Oncology 27:

2103–2110, 2016

• 2. Jakafi PI July 2017

• 3. REARRANGE Trial (clinicaltrails.gov #NCT02835924) (currently unpublished)

• 4.Stivarga PI June 2017

Thank you!

October 18-20 | Orlando, FL

FALL SUMMIT 2017 2nd Annual

Documents

Positive Quality Interventions