Effective Implementation of Quality Care Programs for Patients With Myeloproliferative Neoplasms - Episode 6

Pharmacist Considerations for MPN Medications

The panel discusses aligning quality care initiatives with stakeholder considerations for MPN medications.

Ryan Haumschild, PharmD, MS, MBA: Let’s talk about implementing quality care programs. We talked a lot about how we develop the programs. Jeff, maybe you can start by describing an MPN [myeloproliferative neoplasm] quality initiative that you’re doing. Talk to me a little about what triggered it. Who are the key stakeholders that were involved? How have you been implementing it? How are you measuring it? At the end of the day, how do you think it’s going to improve that unmet need moving forward around these patients with MPN?

Jeff A. Gilreath, PharmD: That’s a great question. In an academic institution, we at the University of Utah service a 5–surrounding state catchment area. We have patients who travel hundreds of miles. Like Sharita said earlier, we get referrals for refractory cases. Eventually, many of these patients will progress and transform. There may be the opportunity for bone marrow transplant that we want to send patients for consult, and they may ultimately go on to receive a bone marrow transplant. But that’s not without its risks. It carries a significantly high mortality rate in this patient population. We want to be judicious and thoughtful about the approach in who we send for transplant, especially if we could treat them with available therapies and extend their life and offer good quality of life for years or decades to come.

The initiative that recently arose was triggered out of the number of patients who we transplanted over the past decade. We looked at their outcomes to see how well they did. We looked at relapse rates and nonrelapse-related mortality to figure out what we could do better as we send patients for transplant referral. Are there certain opportunities that we can take with their conditioning regimen to deepen the response before transplant to reduce the risk of post-transplant relapse?

With the advent of these newer therapies coming about, we met with our blood and marrow transplant team to design a different conditioning regimen that incorporates newer agents into the pre-transplant conditioning regimen. Moreover, we identified reasons for noninfection mortality, whether it be infection or other reasons. We’re looking at that to ensure that our patients are in the best condition possible as they go into the transplant period.

Ryan Haumschild, PharmD, MS, MBA: Excellent. Thanks for sharing that. I like the way you looked into the problem. You went ahead and dug a little deeper, saw there’s an area of opportunity, and got the team involved in that care. It’s a great example. I appreciate that.

Sharita, as we build upon some of your experience in quality improvement programs, you talked to us a little bit about them, but maybe you could go a little more in depth in terms of what triggered it? How do you get key stakeholders involved? What do you feel like will meet the unmet need in current state?

Sharita Howe, PharmD: Especially in the community practice in practices that have this MID [medically integrated dispensing] model, it’s getting pharmacists involved with the management of disease. What I noticed at our particular practice, and what I was guilty of myself, was not paying as much attention as I should to patients with MPNs. When we think about Hydrea [hydroxyurea] and anagrelide [Agrylin] and some of these agents that are used to treat MPNs, they’re not considered specialty medications. They’re cytoreductive, but they’re not specialty.

A lot of times in the MID setting, we focus a lot on the specialty medications. I was guilty of it. What I noticed is that with these particular patients, we didn’t know how they were doing on therapy. We weren’t paying that much attention to them. We were doing our refills and then moving on. Some of these patients don’t even have to fill these medications at a specialty network. They can actually fill outside of a specialty network at their regular retail pharmacy. You’re only seeing these patients during office visits, and you’re not paying attention to these patients during the 30 or even 90 days that they may be getting these refills. You don’t have any in-between care. That’s what led to the development of this quality initiative.

A lot of times in a community-based practice, we might not always have the bandwidth to create something elaborate when we first start. At our practice, we usually start with a seed. We’ll say, “This is a problem we’re having. How do we solve this problem?” What we did was we built a questionnaire into our pharmacy software. Now our patients are able to drop down into a queue that has a trigger that every 3 months will ask them a certain set of questions. We were able to build that into our pharmacy software. From there, we can start to collect those data.

It’s important in any practice that you identify the patients who you want to engage and the patients who you want to collect data from proactively. That way, when we go to some of our key stakeholders, like our physician champion or the clinical director, we can say, “Look at what we’ve been doing in the pharmacy, and look what we’ve been noticing about our patients,” or “Look at some of the things we’ve discovered about our patients that we were missing beforehand.” I felt like there was an unmet need for our patients with MPN because their medications aren’t always considered specialty. We need to make sure that we’re homing in on these patients so that we’re giving them the best opportunity to perform the best on their medications.

Ryan Haumschild, PharmD, MS, MBA: You talked about so many benefits. It’s great to see how you’re helping that patient journey because we know there’s a continuum of care. It doesn’t just involve when it’s being prescribed or when that follow-up visit is happening. We need to be constantly reassessing our patients and asking ourselves, how are they doing? Are there any adverse effects that they’re experiencing? Can we work through that? That’s great that you and your organization have taken on the initiative to shore up that gap.

Transcripts edited for clarity.