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Transitions Magazine

Transitions is published bi-monthly for members of the APhA New Practitioner Network. The online newsletter contains information focused on life inside and outside pharmacy practice, providing guidance on various areas of professional, personal, and practice development. Each issue includes in-depth articles on such topics as personal financial management, innovative practice sites, career profiles, career development tools, residency and postgraduate programs, and more.

Interprofessional collaboration: The key to optimal patient outcomes
Tom English

Interprofessional collaboration: The key to optimal patient outcomes

CAREER PROFILE

Interprofessional collaboration is vital to successful health care teams. Patients rely on the knowledge that each provider brings to the team to provide optimal care. I am fortunate enough to practice at a site where the value pharmacists bring to the team is not only recognized but highly relied upon. For me, this is a regular part of my day as a hematology/oncology pharmacist.

Here are two recent examples of patient interactions where my contributions as a team member were critical to the treatment plan.

Finding a more appropriate treatment

For Patient Number One, I was covering a day off on an inpatient hematology service. This service receives admissions for planned chemotherapy, and patients having complications with lymphoma and multiple myeloma. The team consists of an attending hematologist, several nurse practitioners or physician assistants, patient care resource managers, social workers, a clinical pharmacist, and occasionally a hematology/oncology medical fellow and a hematology/oncology pharmacy resident. For this patient, their lymphoma had relapsed, and the outpatient attending was asking if the inpatient team could investigate epcoritamab versus glofitamab (two bispecific antibodies indicated for diffuse large B cell lymphoma). 

What is important to know with these two medications is that they bind to CD20 on the lymphoma cells and CD3 on T-cells, helping the T-cells recognize what to attack. Most lymphomas are CD20+, meaning they have CD20 on their cells. However, some lymphomas are CD20- or they can lose their CD20 positivity after being treated with other medications, like rituximab. While reviewing the patient’s pathology, I read in previous notes that the patient was CD20- after treatment with rituximab. I confirmed this on the pathology of the most recent biopsy and brought it to the attention of the team. Because they were CD20-, neither epcoritamab or glofitamab would be able to bind to the lymphomas cells and would not be able to work. This allowed the team to find a more appropriate treatment for the patient.

A quicker diagnosis    

For Patient Number Two, I was covering a long-term vacancy at an outpatient breast clinic, a team that consists of an outpatient oncologist, a nurse practitioner, clinic nurses, and occasionally, a hematology/oncology medical fellow. The patient had been doing well on a therapy containing pembrolizumab. However, they came in with glucoses in the high 300s and no past medical history of diabetes. Immune mediated diabetes is a rare complication of immunotherapy, and the oncologist had never seen it before. He was worried about admitting them for “just for high glucoses,” which were repeated and confirmed. 

I proposed the alternative perspective, that if we did not admit this patient, they could develop diabetic ketoacidosis. Ultimately, he chose to admit the patient. I discussed which labs were needed for diagnosis, we drew them prior to admission, and got the diagnosis of immune-mediated type 1 diabetes sooner.

Every intervention matters

Although these are only two examples of how working on an interprofessional team has improved patient outcomes, not a day goes by that I’m not able to work with my teams to make an impact on patient care. It does not matter whether you are a community pharmacist, hospital pharmacist, or other, every intervention matters.

Allison Reed, PharmD, BCPS, BCOP, is a hematology/oncology pharmacist at The James Cancer Hospital at Ohio State University in Columbus, OH, and a member of the 2023–2024 APhA New Practitioner Network Communications Standing Committee. She is passionate about cancer care, and enhancing patient care for underrepresented and underserved populations. She also loves watching movies, cooking, traveling, and spending time with friends, family, and her dog, Trixie.

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