UP FRONT care nurse to assess the correctness of the pillbox setup can be useful .
6 . Use calendars , phone reminders , and automated electronic alarms . Extensive research into effective adherence strategies in chronic health conditions has shown that building paper-and-pencil or electronic calendars , using phone reminders , and setting up automated electronic alarms improve adherence . We need to use all of the tools at our disposal .
“ Often , the reason for non-adherence is unintentional ; the patients are simply not sure what medications to take , when to take them , and for how long to take them . As much as clinicians try to review the treatment plan and communicate their intentions with patients , these are not always received or processed by patients or family members .”
7 . Collaborate with your multidisciplinary team to facilitate effective patient care . Work as a team with nurses , hematologists , and primary-care professionals to make sure patient concerns are addressed . For example , if a patient is experiencing steroid-induced hyperglycemia or uncontrolled hypertension , would he or she benefit from seeing an internist or APP to help manage this condition ? Or , for a 90-year-old patient without risk factors for heart disease , could a cardiologist help determine if any medications , such as atorvastatin , could be eliminated from the treatment plan ?
8 . Help the patient by refilling medications on time . If your office has a standard system for refills , the patient needs to know how to request refills . In my practice , I find the fax reminders and side effect monitoring that specialty pharmacies send to be very helpful . By partnering with the specialty pharmacies , patients can be sure to receive the medications they need in a timely manner – and that they remain consistent in the dosing and scheduling of medication . To help , I also encourage that the patient always start the medication on a set day ( i . e ., at the beginning of the week on Monday ) and to be consistent .
9 . Ask patients to bring their medications to each visit to review . Not all providers have sufficient time to review medications and patients ’ adherence to the regimen , but every once in a while , I make a point to set aside time for a thorough review – especially when patients report experiencing unexplained side effects . If I don ’ t have time , I will try to find a pharmacist or nurse in the office who has time to review the medications . For patients who are taking multiple medications , I will try to review the medications and the patients ’ status to see if any can be eliminated to decrease pill burden and the possibility of drug-drug interactions .
10 . Follow up with phone calls or appointments after hospitalization to assess for side effects . A quality improvement project conducted at Cleveland Clinic showed that non-surgical cancer patients who received a phone call follow-up within 48 hours of hospital discharge and had a follow-up appointment with a provider within one week of discharge were less likely to have an unplanned readmission . 7 Although multiple factors influenced readmission ( such as disease status , tumor type , and willingness to adhere to therapy ), the study demonstrated that a protocol for telephone communication is a logical , systematic way of interacting with patients and addressing disease or treatment-related side effects and reinforcing the care plan .
We , as providers , ask a lot of our patients . Keeping these 10 tips in mind can help enhance adherence to therapy , which will hopefully decrease patients ’ anxiety and confusion and improve their outcomes . ●
Beth Faiman , CNP , PhD , is a certified nurse practitioner at the Cleveland Clinic in Cleveland , Ohio .
REFERENCES
1 . Faiman B . Medication self-management : important concepts for advanced practitioners in oncology . J Adv Pract Oncol . 2012 ; 2:26-34 .
2 . Kurtin SE , Colson K , Tariman J , et al . Adherence , persistence , and treatment fatigue in multiple myeloma . J Adv Pract Oncol . 2016 ; 7:71-7 .
3 . Accordino MK , Hershman DL . Disparities and challenges in adherence to oral antineoplastic agents . Am Soc Clin Oncol Educ Book . 2013:271-276 .
4 . Prithviraj GK , Koroukian S , Margevicius S , et al . Patient characteristics associated with polypharmacy and inappropriate prescribing of medications among older adults with cancer . J Geriatr Oncol . 2012 ; 3:228-37 .
5 . LeBlanc TW , McNeil MJ , Kamal AH , et al . Polypharmacy in patients with advanced cancer and the role of medication discontinuation . Lancet Oncol . 2015 ; 16:333-41 .
6 . Faiman B , Jacobsen P , Still N , et al . Patient reported symptoms , concerns and provider intervention in patients with multiple myeloma . Abstract JL314 . Presented at JADPRO Live , November 5 , 2015 ; National Harbor , MD .
7 . Montero AJ , Stevenson J , Guthrie AE , et al . Reducing unplanned medical oncology readmissions by improving outpatient care transitions : a process improvement project at the Cleveland Clinic . J Oncol Pract . 2016 ; 12:594-602 .
Attention APPs : Free CME Summit on Myelodysplastic Syndromes Improving MDS Outcomes from Diagnosis to Treatment : A Multidisciplinary Approach
There are many complexities associated with myelodysplastic syndromes ( MDS ) that a multispecialty team must address as a clinical-care unit . These complexities include obtaining adequate bone marrow specimens , identification and classification of MDS , the comorbidity rate of MDS patients , and the decision-making process for treatment . To address educational gaps associated with these complexities , the American Society for Clinical Pathology ( ASCP ), the American Society of Hematology ( ASH ), and the France Foundation have designed comprehensive MDS-directed educational summits that feature live events designed by world-class subject matter experts . Participants of these summits will actively engage in multidisciplinary , interactive small-group activities including case-based tumor board discussions and four break-out sessions on :
• The role of molecular testing
• Distinguishing morphologic mimics from MDS
• Assessing low- or high-grade MDS
• Applying new prognostic scoring to cytogenetics
Who should attend ?
• Hematologists
• Medical oncologists
• Hematopathologists
• General pathologists
• Pathologists ’ assistants
• Physician assistants
• Hematology and oncology nurse practitioners and physicians assistants
• Medical laboratory scientists
Dates and Locations Registration is free . Go to either hematology . org / Meetings / 4127 . aspx or pathologylearning . org / mds / summits to register .
November 4 , 2016 Austin , TX Hyatt Regency Austin
Registered attendees at the ASCP Annual Meeting or the 58th ASH Annual Meeting and Exposition may register for the following events for free .
December 3-6 , 2016 San Diego , CA Held in conjunction with the 58th ASH Annual Meeting and Exposition
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