Home Pharmacy practice Decision trees in hematological malignancies: a study identifies the main triggers

Decision trees in hematological malignancies: a study identifies the main triggers

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Medication reconciliation and pharmacist advice are essential to the clinical management of patients with hematological malignancies.

Advanced age is a risk factor for hematological malignancies. It also complicates the management of hematological malignancies due to comorbidities, polypharmacy, poor compliance and mortality associated with advanced age.1

Medication reconciliation and pharmacist advice are essential to clinical management, but these activities are time-consuming and require teams to optimize resources.1 Medical teams must identify the patients most at risk of medication errors in order to prioritize the management of these patients.

The aim of a study published in the Journal of Oncology Pharmacy Practice was to build a decision tree to optimize the pharmaceutical consultation of elderly patients with hematological malignancies.1 The study included patients from the Limoges University Hospital between January 2017 and August 2018. The patients were aged 75 and over, were treated on an outpatient basis for hematology and cell therapy, and had a hematological malignancy treated with chemotherapy.

The researchers followed the patients for 3 consultations, the first on inclusion, the second at 1 month and the third at 3 months. The study assessed sociodemographic characteristics, frailty status, potentially inappropriate medications, cholinergic medications, self-medication, prescription complexity, polypharmacy, and renal function.1

Researchers identified pharmaceutical interventions (PIs) in 87.3% of patients, the most common of which was non-compliance with national guidelines. Patients with potentially inappropriate medications were significantly associated with female gender, polypharmacy, and the presence of an anticholinergic drug. Frailty was a protective factor for being prescribed an anticholinergic drug.1

Based on the results, the researchers created a decision tree, which serves as a guide for the team to prioritize patients for consultations. A specialist nurse performs frailty screening and targeted drug screening for all chemotherapy patients.

A pharmacist will advise suitable patients taking 10 or more prescriptions. Fragile patients receive a pharmacist consultation if they are taking 5 or more drugs or targeted drugs. The follow-up consultation takes place at 1 month then every 3 months for all patients having at least 1 pharmaceutical intervention.

The researchers developed the decision tree to optimize therapeutic management while improving the use of available pharmaceutical resources. The multidisciplinary strategy aims to improve the quality and safety of elderly patients with hematological malignancies.

About the Author

Lindsey Sawtelle is a 2022 PharmD candidate at the University of Connecticut.

Reference

Strumia M, Fargeas JB, Marcellaud E, et al. Development of a decision tree for pharmacy consultation of elderly patients with hematological malignancies [published online ahead of print, 2022 Feb 28]. J Oncol Pharm Pract. 2022;10781552221080419. doi:10.1177/1078155222108041