Consultant Pharmacist University Hospitals of Leicester Leicester, United Kingdom
Introduction: Haematology services in the UK are under increasing pressure due to increased demand and difficulties in recruiting haematologists. In addition, there has been a significant increase in the number of drugs approved in myeloma with the majority of these continued until progression. The British Society of Haematology Annual Scientific meeting 2023 highlighted work-force issues and the use of allied healthcare professionals to deliver novel models of care to address this. The UKMS (UK Myeloma Society) Pharmacy group conducted a survey to understand the extent and nature of pharmacist prescribing within the UK myeloma setting
Methods: Pharmacist Independent Prescribers (PIPs) working within Myeloma clinics in the UK, were invited to complete an MS (Microsoft ™) Forms survey (31 questions), exploring the scope and nature of their practice including barriers and enablers. Several questions were “select all that apply”.
Results: 27 PIPs responded. All respondents worked in NHS (National Health Service) trusts. The mean duration of time worked in the myeloma outpatient setting was 3.4 years (range < 1-10).
Training: all respondents are qualified PIPs. Additional training undertaken included communication skills (22%), ordering imaging (11%), clinical skills (11%) and in-clinic training (7%)
Clinic models: various models have been implemented; these included consultant-led (n=20), pharmacist-led (n=8) and joint nurse and pharmacist clinics (n=2). Consultation type varied with respondents reporting undertaking telephone reviews, face to face or a combination of both.
Clinic capacity: most respondents are carrying out one clinic per week with frequency ranging between less than weekly to more than 3 clinics per week. The mean number of patients reviewed in each clinic was 7.1 (range 2 to 14).
Clinical activity: 19 respondents reviewed all patients irrespective of the treatment regimen. 7 reviewed follow-up patients on treatment, 13 reviewed follow-up patients on or off treatment and 2 also reviewed new patients. Other roles undertaken included delivering bad news (56%), consenting patients for systemic anticancer therapy (SACT) (22%), completing Blueteq requests (30%) treatment break forms (37%), attending MDT (74%) and counselling patients on SACT (93%).
Barriers: Of those who experienced barriers, the most common number of barriers faced was two (1-5). The most commonly cited barrier was “lack of room capacity” (n=7) followed by “no allocated time in job plan” and “no funding to backfill pharmacy role” (n=6). Only 2 PIPs cited a “lack of clinical engagement” as a barrier.
Conclusions: Pharmacists are an integral part of the Myeloma Outpatient MDT reviewing and prescribing for a wide range of patients and undertaking extended roles. Reassuringly, clinician engagement is more commonly an enabler rather than barrier to PIPs working in clinic. This demonstrates that, with appropriate investment and training, specialist pharmacists can expand capacity within myeloma clinics.
