Continuity of care in pharmacy

(L-R) Dr. Linda Hensman, Scott Edwards, Jennifer Loder and Rick Abbott.

Research done over the summer by MUN pharmacy student Jennifer Loder, under a summer research award from Apotex Inc., helped lay the foundation for a major research study at the Newfoundland Cancer Treatment and Research Foundation (NCTRF) which has received $100,000 grant from Pfizer Canada. This will be the first randomized controlled research project in Canada on seamless care which will measure outcomes relating to clinical oncology pharmacy practice.

“One of the biggest problems we face in healthcare is communication,” explained Dr. Linda Hensman, director of the School of Pharmacy. “Communication amongst ourselves even within one setting is fraught with problems and becomes that much more complicated when patients move from one health care setting to another. All too often that's when problems start to arise because each member of the health care team may not be aware of the care received or the intended treatment within the new setting.”

Recognizing these challenges, the NCTRF is introducing a project in seamless care. “Seamless care is the desired continuity of care as patients move from one healthcare environment to another throughout the course of their treatment,” said Scott Edwards, a clinical pharmacist with NCTRF and the study's primary investigator.

During the summer, Ms. Loder developed and implemented an oncology pharmacy patient care database. She conducted a survey of hospital pharmacists in the province and determined their current practices and information needs relating to cancer care patients. Based on this information a database was developed. Additionally, Ms. Loder conducted a pilot project on seamless care, the results of which were used to form the basis for the funding from Pfizer, announced Nov. 16. The database is currently used to provide seamless care for Newfoundland and Labrador oncology patients and will be used as the sole database for the research project.

All solid tumor cancer patients in the provinces are seen at the Dr. H. Bliss Murphy Cancer Centre, where a medical oncologist determines an appropriate course of chemotherapy. If necessary, the patient is referred to a regional cancer centre for treatment. That's where seamless care comes in.

“Scott will be talking to patients about their chemotherapy regimen and side effect management,” said Rick Abbott, provincial pharmacy director and co-investigator on the project. “This interaction increases the patient's knowledge of their own treatment and helps them be more responsible for their own care.”

The seamless care project will ensure that the regional hospital pharmacists who are responsible for the provision of chemotherapy are aware of a patient's specific treatment regimen and are kept up-to-date with what happened to the patient while they were at the Cancer Centre. Dr. Hensman noted that it is a challenge for regional hospital pharmacists to be as knowledgeable as specialty practitioners in terms of cancer treatment protocols since the number of patients is often small and the treatment regimens are varied and frequently change.

Before patients leave St. John's to begin their chemotherapy treatment in a hospital or community-based setting near their home, Mr. Edwards will conduct a complete medication history with them, verify it with their community pharmacist and add the information to their chart. He will cross-check new medications against the patient's established drug regimen for any possible drug interactions, confirm dosages against established protocols and verify pertinent lab results. All this information will be entered into the database and then be electronically communicated to the hospital pharmacist overseeing the preparation of the chemotherapy. It may also be forwarded to the oncology nurse and the attending physician. “No information is sent without the patient's permission, but to date there has been 100 per cent co-operation,” said Mr. Edwards.

The study will involve over 200 patients and is the first of its kind in Canada. “We hope to see improvements in clinical, humanistic and economic outcomes that may change the face of oncology pharmacy practice in Canada ,” said Mr. Edwards.

Dr. Hensman said, “It is exciting to see that a work done by a undergraduate pharmacy student as part of a summer research project can serve as the basis for a major research initiative which has the potential to significantly impact the health of Newfoundlanders and Labradorians faced with a diagnosis of cancer.”