Oral chemotherapy: Improved medication outcomes in private practice.
Bibliographic record
Abstract
e20691 Background: Despite the perception that oral chemotherapy is less toxic than intravenous therapy, they pose their own unique challenges in terms of acquisition, education, side effect management and adherence. We sought to evaluate the impact of incorporating Michigan Oncology Quality Consortium’s (MOQC) defined oral oncolytic processes had on improving medication outcomes. Methods: A retrospective chart audit was conducted of patients who were prescribed oral chemotherapy between May 2011 and July 2013 including: date prescribed, the actual patient start date and any reported problems with their medications. Subsequently, our practice joined the MOQC initiative, which included four major components: implementation of care manager, self-management focused education, the Edmonton Symptom Assessment System and an adherence monitoring tool. A repeat audit was conducted from August 2013 to March 2014, following incorporation of workflow changes. A T test was performed. Results: 25 patients were in the first cohort and 24 in the second- post intervention cohort. In the first cohort, 13/25 patients had a documented start date, and of these 13, 10 had ≥ 4 weeks delay to actually starting their oral chemotherapy, 3/13 had a 2-4 week delay to start treatment. 12 /25 patients discontinued their drug within the first month due to side effects without consulting their physician. In the second-post intervention cohort, 24/24 patients had the start date documented; 24/24 started therapy 1 week after the prescription was written. Post intervention, there were no self-discontinuations of the drug and four physician-directed dose reductions. Differences between start date documentation compliance and, self-discontinuation of medication pre and post intervention are statistically significant with p-value < 0.001. Conclusions: A multi-disciplinary approach involving the introduction of a care manager, self-management education, and enhanced symptom and adherence monitoring lead to earlier recognition of symptoms and intervention. This lead to greater adherence to oral chemotherapy regimens for our patients. Pre Post p-value Start Date Documented 13/25 24/24 < 0.001 Self-Discontinuation of Drug (without MD evaluation) 12/25 0/24 < 0.001
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.021 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".