P-143: Breakthrough – a designated pharmacist in the hemato-oncology department improves both quality and sequence of drug treatment and reduces ADR in Multiple Myeloma patients during Covid-19 pandemic

BACKGROUND: In March 2020, COVID19 break out and since then the world has been facing a new reality. Multiple Myeloma patients due to their disease and chemotherapy were considered as a high-risk group for infection. Since then, in an attempt to avoid multiple exposures, encounters between patients and caregivers have diminished negatively affecting the sequence and quality of drug treatment. OBJECTIVES: Improving Quality, Sequence of Drug Treatment and reducing adverse drug reactions(ADR) in MM patients during Covid-19 pandemic. METHODS: This study is part of a broader randomized controlled trial. It included 44 MM adult patients, who received chemotherapy or biological therapy at Carmel Medical Center in Isreal. Once they sign a consent form, they were randomized into two groups (23 Intervention, 21 Control). In the intervention group, the pharmacist examined the patient’s entire medical treatment and sent recommendations to the family physician and hematoocologist. On the day of the treatment, the pharmacist has met with the patient and provided him/her with a discharge counseling in addition to close supervision for 4 months during the treatment period. The control group was treated without increased pharmacological intervention. The data collection phase had ended one month after intervention period. The control group data was examined after the end of treatment to prevent ethical dilemmas. The variables that were examined are compliance, ADR and balancing medical incidences. RESULTS: Intervention group: it was found that 65.2% of the patients did not take their medication according to the manufacturer’s instructions, 8.7% took medication that were not registered in their medical file, 30.4% took medication at a different dose than recommended, 56% of patients had poor compliance to one or more prophylactic treatments. 90 recommendations were sent to the hemato-oncologist - 79 (87.7%) were accepted. 57 recommendations were sent to the family physicians and 40 (70%) of them were accepted. During the follow-up period, an improvement of 100% in adherence to the manufacturer’s instructions, 100% of the medications were registered in the patient’s file and the response to prophylactic treatment increased to 96%. Among the patients in the intervention group, there was an improvement in the indices of diabetes balance (13%), LDL (34%), vitamin D (30%) and GFR (34%). This is in comparison with an improvement of 4.7%, 9.5%, 23% and a 14% in the control group. During the follow-up period in the intervention group 7 cases of ADR were reported compared to 19 cases in the control group. CONCLUSION: We found that integrating of a designated pharmacist as part of the hemato-oncology department during the Covid-19 pandemic had high positive effect on the quality and sequence of drug treatment and reduced the incidence of ADR “Crisis is also an opportunity” – integrating a designated pharmacist should be considered even in routine days.