Ilyse Kenis, Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, UGent, Ghent, Belgium
Veerle Foulon, Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven, Belgium
ABSTRACT
Background
Considering the home-based character of oral anticancer therapies (OACT), the general practitioner and community pharmacist (CP) are important players in the follow-up of these patients. However, collaboration between primary and secondary care (SC) is currently impeded by various barriers, such as lack of communication and absence of a shared electronic patient record. Often, CPs are not informed by the hospital about the start of OACT.
Purpose of study
The aim of this pilot project is to support transmural communication between SC and CPs at the initiation of an OACT using “The Envelope”. By improving information transfer between these two settings, we hope to enable CPs to perform medication reconciliation at treatment-initiation and assume a (more) substantial role in counselling and follow-up of patients on OACT.
Method
In December 2021, the oncology departments of two Flemish hospitals started using “The Envelope” as a tool for transmural communication with CPs. Patients starting a new OACT received an envelope upon their consultation in the hospital. The envelope is intended for the CP and should contain the following documents: an information letter, an information leaflet on the OACT, and a medication therapy plan from the hospital. Upon receipt, CPs are asked to scan a code, as to register the number of envelopes that make it from the hospital to the pharmacy. Furthermore, CPs are asked to complete an online survey on what actions were taken and/or problems were detected using the information in the envelope.
Results
By April 2022, 25 envelopes were received by a CP. Of those CPs who received an envelope, 16 completed the online survey. The CPs received the envelope from the patients themselves (N = 11) or from their caregiver (N = 5). The ensuing counselling interview lasted on average 14 min (2 min – 60 min). Several actions were taken by the CPs: an extensive conversation with the patient/caregiver about the OACT or other medication (N = 14), adding the OACT to the patient’s medication history in the pharmacy software (N = 8), providing intake instructions (N = 3), contact with hospital pharmacist (N = 2), and substitution to the original drug (N = 1). Only 10 out of 16 envelopes contained a medication therapy plan from the hospital. Seven CPs compared the schedule to other available information (e.g. prescription(s) from the hospital, medication history, previous medication therapy plan, information from the patient/caregiver). One discrepancy (two drugs of the same class) and one drug-related problem (inadequate adherence to co-medication) were discovered.
Conclusion
Based on these preliminary results, the envelope seems a valuable and efficient tool for communication between SC and CPs that can be used as an intermediate solution in anticipation of a shared electronic patient record. The envelope seems to enable CPs to take up a role in the counselling of patients upon initiation of OACT and perform a medication reconciliation.