"Pharmacist Integration into the Hemophilia Treatment Centre: A Canadian Pilot Project to Optimize Treatment and Improve Cost-Savings Using Pharmacokinetic Assessments of Hemophilia Patients"
Nisha Varughese, Régis Vaillancourt, Sylvain Grenier, and Sarah Jennings
Children's Hospital of Eastern Ontario and Canadian Blood Services
Background: Hospital pharmacists have traditionally not been involved with hospital blood banks or hemophilia clinics. However, coagulation factors used in the treatment of hemophilia follow complicated pharmacokinetic (pK) trajectories with tremendous inter-individual variation, and the optimal use of these products involves systematically assessing and interpreting the pK profiles of all patients. This makes hemophilia care an ideal therapeutic area for pharmacist involvement.
Objectives: Canadian Blood Services manages a national formulary of about 50 plasma protein and related products (PPRP) on behalf of provincial and territorial governments (excluding Quebec). As formulary manager, they recognized an opportunity for substantial savings without compromising patient care by individualizing doses and regimens and switching to lower cost products when clinically appropriate.
Method: Canadian Blood Services partnered with the Children’s Hospital of Eastern Ontario (CHEO) on an innovative project integrating a pharmacist into the Hemophilia Treatment Centre (HTC). The pharmacist attended clinics, educated staff and patients, developed policies, and conducted pK evaluations.
Results: In less than one year, pharmacist interventions reduced annual treatment costs for 15 patients by $355,000. In a preliminary analysis, 1 patient had no change in bleeding events and 14 patients had fewer bleeds.
Conclusions: The results of this innovative project show promise for a new practice area for pharmacists.
Leadership during a crisis
Horizon Health Network, New Brunswick
Background : Leadership during a crisis requires looking out for the needs of others. Leaders need to act decisively while considering input from followers, stakeholders and clients/patients. A disaster or pandemic plan can help guide the preparation, initial response and recovery phases however leaders also need flexibility to adjust to rapidly changing conditions and to be open to opportunities when others will see barriers.
Objective(s) : To describe strategies and tactics used to manage a regional multi-site pharmacy service in the early months of the COVID-19 pandemic.
Methods : Various approaches were used during the pandemic of which several will be described as successes and lessons learned in leading teams with communication, visioning, setting expectations for staff, attending to relationships and maintaining positive staff morale.
Results : Examples to be shared of leveraging communications to build trust and inspire staff, pivoting staff to ensure redundancy in priority roles, managing inventory of essential medications and COVID vaccines, and building new bridges with other internal departments and external partners.
Conclusions : Effective leadership in a crisis demands the leader communicate clearly, concisely and with purpose. Varied methods are often needed to keep staff informed and inspired, to maintain trust and focus on delivering essential services even when conditions may be changing and beyond one’s control.
Development of a patient-centered video series to improve outcomes for kidney and lung transplant patients
Holly Mansell and Nicola Rosaasen
Saskatchewan Transplant Program, Saskatchewan Health Authority, Saskatoon, SK
Background: Inadequate patient knowledge contributes to poor patient outcomes after transplantation. Kidney and lung transplant patients have indicated that the transplant process is confusing, and they want more education.
Objectives: 1) Conduct a needs assessment to determine optimal format and content, 2) develop a patient-centered educational intervention for kidney patients, 3) test the intervention’s effectiveness, 4) develop a similar resource for lung transplant patients.
Methods: Three studies were undertaken providing qualitative and quantitative feedback from patients on the kidney waitlist, kidney transplant recipients, and health care providers working in transplantation. A video series was created for kidney patients by engaging patient-stakeholders, experts in medication adherence, video education, motivational psychology, and cultural education. Two randomized-controlled trials were designed to test the videos delivered electronically in pre- and post-transplant cohorts. Consultations with patients and caregivers from the lung association informed the content for lung transplant videos.
Results: ‘Solid Organ Transplantation: An Educational Mini-Series for Patients’ is a 6-part video series outlining the kidney transplant process in its entirety. The videos range between 3 and 24 minutes in length, are patient friendly in design, and incorporate animations to explain complex information to accommodate individuals with low health literacy. Patient testimonials align the content with principles of the adult learning theory. A similarly designed but newly scripted version of the series is intended for the lung transplant audience. Two multicenter, parallel arm, randomized controlled trials are currently being conducted to test the kidney videos (delivered electronically) in pre- and post-transplant cohorts, with collaborators from Saskatoon, Regina, Calgary, Edmonton, Halifax and Chicago.
Conclusion: These studies aim to determine whether electronic education can improve transplant knowledge, patient satisfaction and other patient outcomes (e.g. medication adherence). If proven beneficial, these interventions can be easily implemented and provide consistent, repeatable patient education at low cost, with little impact to existing health care personnel.