CLINICAL ROLE –
Medically integrated dispensing specialty pharmacies can connect patient medical and pharmacy records to improve medication adherence and help patients to safely stay on them for longer.
Kristen Whelchel, PharmD, CSP, Research and Patient Care Improvement Pharmacist, Vanderbilt University Medical Center, Nashville, Tennessee,sits down with Pharmacy Times to discuss medically integrated dispensing specialty pharmaciesat the Academy of Managed Care Pharmacy’s (AMCP) Nexus 2023 Conference, happening October 16 through 19 in Orlando, Florida. Whelchel explains the expanded role of the pharmacist in this role and how these pharmacies have access to medical and pharmacy records to facilitate a comprehensive approach to patient treatment.
Pharmacy Times Staff: What are the benefits of medically integrated dispensing specialty pharmacies compared to mail-order pharmacies?
Kristen Whelchel, PharmD, CSP: That's a great question. Medically integrated dispensing pharmacies do have some advantage over your typical mail order pharmacy. Typically, like the Vanderbilt Specialty Pharmacy, we have specialty pharmacist embedded in the clinics where the patients are being seen by their providers. The pharmacists are heavily involved in the patient journey, from pretreatment all the way through to treatment monitoring. Once the patient is established on care, we do a lot to get access to medications for patients and make decisions. One of the great things that helps us with that is that we do have access to the patient's medical records as well as their pharmacy records. So we can really just close the loop for the patient so that they are getting all of their care in one place. And there's no disconnect between the different the different parts of parts of treatment for patients.
Pharmacy Times Staff: What are the quality measures used for oral oncolytic medication adherence, persistence, and waste that pharmacists should be aware of?
Kristen Whelchel, PharmD, CSP: I do think that it that quality measures in oncology is a little bit tougher than some other disease states. Like we talked about earlier in our presentation, it's not uncommon for patients on oral oncolytics to have medically necessary holds and treatment that could be due to a side effect or something that's going on within their treatment course. So they might look less inherent than they really are. I do think that medically integrated dispensing pharmacies can really step in here and shed light on why patients may appear to be less adherent. That is information that we gather; if a patient has been instructed to hold medication for whatever reason, that is data that that we collect for patients. Persistence, I feel like in oncology space, can be a little bit harder. [Because] A lot of times with these medications, we are trying to prevent progression, not necessarily cure a disease. So that's a little bit harder. But we do want to make sure that we are monitoring how long patients are staying on therapy, and we're providing them the support that they need so that they can stay on therapy as long as possible at the highest doses they can. We definitely do tailored monitoring for specific drugs, where we're reaching out to patients at specific times in therapy when they're most likely—depending on what medication they're taking—to have adverse effects. And we're providing that support for patients. So there are medical quality measures. I feel like as a medically integrated dispensing (MID) pharmacy, we do have that extra benefit of having all of the patient's information, and we do a lot of documentation. So when there is a discontinuation, or hold, or a patient is having some type of problem, we are managing that for the patients.
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