Effective Implementation of Quality Care Programs for Patients With Myeloproliferative Neoplasms - Episode 7

Navigating Barriers to Care for Patients with MPNs

Highlighted are proposed solutions for current barriers to care for MPNs.

Ryan Haumschild, PharmD, MS, MBA: Going through this entire talk, it seems like there are so many benefits to quality initiatives around MPNs [myeloproliferative neoplasms]. But I feel like not everyone is doing it. Jeff, why are others not taking advantage of improving these quality improvement projects? What barriers are people running into? Why isn’t it more widespread in terms of patient management?

Jeff A. Gilreath, PharmD: The answer to that question is multifactorial. A lot of it has to do with the resources available to you. As pharmacists, we wear many hats. We’re educating students and residents. We’re working with our IT [information technology] department to build infrastructure to make these medications orderable. We’re chasing down prescriptions to make sure they get filled and are paid for by payers. We’re signing up patients for copay assistance. We’re spread thin. We’re asked to do more and more. Time is an opportunity cost. If you’re deciding to focus on 1 project, there’s another project that may suffer from lack of attention. Also, not having an MD champion prevents a lot of forward-thinking and process improvement.

At our center, we have several dedicated hematologists who see patients with MPN, and that has enabled us to start new clinical trials and partner with other centers overseas to offer new treatments at our center. I can’t say enough about having someone champion the care of these patients. We don’t work in isolation. No one does it alone. We need to reach out and work with others.

Ryan Haumschild, PharmD, MS, MBA: Having a physician champion is important. I can speak to that as well. I have the chance to work with some awesome hematologists. You do need their buy-in, especially as we’re working on collaborative practice agreements for pharmacists to treat these patients, to be part of the initiation of supportive care medications or to titrate doses. You have to have someone who’s also going to be an advocate of that practice for pharmacy. That’s important. That’s a barrier, because even if it’s a great academic practice, not everyone has those champions. If they do, there’s varying levels of engagement. I’d love to see that improved.

When we think about barriers, you talked about electronic medical record [EMR] data and building in some of these functional systems that overlay so we can keep track of patients. That’s also very innovative. How do we get that to be more widespread? As we hear about the academic setting and some of the barriers to implementation or how quality improvement projects look in the academic setting, I’ve got to turn to you, Sharita. I love to hear how you complement your view in the community setting. When we think about community and MPNs, you’ve talked greatly about the different projects you’ve done. But how does implementation differ from Jeff? What are some of those barriers that may be unique to the community setting that may not be the same as the academic?

Sharita Howe, PharmD: When we speak to some of the barriers that are available in the community setting, I can’t speak to all community practices, but something that may be difficult is having the bandwidth to be able to take on some of the initiatives associated with MPNs. A lot of times our initiatives start as theses, and from there we have to work our way up. Barriers that we can come across include getting that physician buy-in. Because if the pharmacy itself comes up with an initiative, and we hammer that initiative out but it’s only in the pharmacy, then it still could be broken apart at any time. We need to make sure we’re having that physician champion so we can speak with them and say, “This is what we’ve been doing.” Then from there, we can get buy-in of other stakeholders within the practice. From there, we may be able to build something solid in the EMR.

Some of the initiatives that we start maybe started at the pharmacy level, but our ultimate goal is to make sure that we can get these implemented into the EMR so that they’re long-lasting and we’re not only communicating at a pharmacy level but at a level with the physician team, nurse team, and our patient financial counselors. Sometimes there’s information that they can tease out while completing prior authorizations or trying to get patients approved for therapy. If we’re implementing this and putting it in the EMR, we have a larger picture of what’s going on with our patients. One of the largest barriers in the community practice is being able to get that off the ground because sometimes we’re spread thin and don’t have the time. We need to figure out how to make the time, answer questions and solve problems for these patients, especially with MPNs.

Jeff A. Gilreath, PharmD: I’d add that regardless of what setting you work in, as pharmacists, we tend to be perfectionists by nature. We have to be because dosages must be perfect. Everything needs to be precise. When we think about a quality initiative, we try and package it in this perfect little way before we deploy it or set forth on trying to achieve our goals. That may be unrealistic. Patients can derive a lot of benefit just by putting 1 foot forward in front of the other. Like Sharita was saying regarding the EMR, putting in any level of standardization that you’ve learned from past experience or attending meetings on new therapies will go a long way in benefiting patients, and you can build on this over time. It doesn’t have to be perfect the first time out.

Ryan Haumschild, PharmD, MS, MBA: These are great comments. I’m realizing that so much too is that stakeholder engagement. You can’t just say, “We’re pharmacy. We’re going to carry this through.” You have to create ownership from others in the organization, and that generates that sustainability. That’s important too. We have to come up with ideas and help the team figure out how we improve patient care but get them bought in. I think about that all the time because you can’t get something in the EMR without also engaging others and getting on the priority list. With the pharmacists, it’s also interaction with the team.

Transcripts edited for clarity.