The Impact of a Hematopoietic Cellular Therapy Pharmacist on Clinical and Humanistic Outcomes: A RE-AIM Framework Analysis

Abstract

The hematopoietic cellular therapy (HCT) pharmacist is an essential member of the multidisciplinary care team. Yet, standardized incorporation of a pharmacist at transplantation centers remains challenging. Implementation science uses theory-driven and systematic approaches to integrate interventions into clinical practice. We describe our experience implementing an HCT pharmacist at our center and conducted a program evaluation using the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. We implemented 1 full-time equivalent pharmacist to provide medication management services through a collaborative practice agreement (CPA) to the allogeneic transplantation population at a medium-sized center in rural Pennsylvania over a 2-year period. The HCT pharmacist documented all in-person and telephonic care encounters in the electronic medical record. A pharmacist intervention tool was developed to document identified medication-related problems with corresponding interventions and magnitude of intervention. Summary statistics including frequency and percentages were presented for categorical variables in RE-AIM domain. Over the 2-year period, the HCT pharmacist monitored 40 allogeneic patients at our institution accounting for 1531 patient encounters. The average duration of follow-up was 299 days. The HCT pharmacist medication therapy services were able to reach all allogeneic transplants at our institute. The HCT pharmacist managed 388 medications and identified 2156 medication related problems for which the pharmacist provided 2959 interventions. Time in therapeutic range of immunosuppression was 73.9% when managed by the HCT pharmacist through a CPA. Of the 24 patients and 9 caregivers who completed the patient satisfaction survey, 25 (76%) were strongly satisfied with their care. Pharmacy services were gradually adopted and expanded to incorporate additional populations, including 121 autologous transplant and 272 hematology patient encounters. The role of the HCT pharmacist was justified with hospital administration and sustained as a designated pharmacist role at our center. The implementation of an HCT pharmacist service can positively impact patient care. The RE-AIM framework provides a methodological approach for programmatic evaluation and generalizability. © 2022 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

Keywords: Bone marrow transplant; Clinical pharmacy service; Collaborative practice agreement; Drug therapypharmacist intervention; Hematopoietic cellular transplant; Medication management tool; Medication therapy and disease management; Pharmaceutical service; Pharmacist; Pharmacist intervention tool; Stem cell transplant.