Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Sep 27, 2020
Date Accepted: Jul 15, 2021
Effect of physician-pharmacist participation in the management of ambulatory cancer pain through a digital health platform: A randomized controlled trial
ABSTRACT
Background:
Management of ambulatory cancer pain is a difficult clinical challenge, with opportunities to individualize patient care.
Objective:
We conducted a randomized controlled trial to assess the impact of physician-pharmacist participation in self-management of ambulatory cancer pain by using the WeChat-supported platform—Medication Housekeeper (MediHK).
Methods:
Patients were randomly assigned to either an intervention group (InterG) or control group (CTLG). During the four weeks study period, the participants in InterG completed daily 24-hour pain diaries, adverse reaction (ADR) forms every 3 days and the Brief Pain Inventory (BPI) every 15 days from pharmacists via MediHK, while the participants in CTLG only received conventional pharmaceutical care and any information they proactively requested. The primary outcome included pain intensity and pain interference on daily life. Secondary outcomes included Patient Reported Outcome Measures (PROMs), adherence, adverse reaction (ADRs) and rehospitalization rate.
Results:
A total of 100 patients were included, with 51 in the InterG and 49 in the CTLG. The worst pain scores, the least pain scores and the average pain scores in the InterG and the CTLG were statistically different, with a median value of 4.0 (IQR, 3.0-7.0) vs. 7.0 (IQR, 4.5-8.0) (P = 0.001), 1.0 (0-2.0) vs. 2.0 (IQR, 1.0-3.0) (P = 0.017), 2.0 (2.0-4.0) vs. 4.0 (IQR, 3.0-5.0) (P = 0.001) at the end of the study. Except for walking ability and normal work, pain interference on all areas showed greater reductions in InterG. The total adherence rate increased from 94.1% to 100.0% in the InterG group and 77.6% to 83.7% in CTLG. The overall number of ADRs increased at the four week and more ADRs were monitored in the InterG (P=0.003). Rehospitalization rate was similar between the two groups.
Conclusions:
With the help of MediHK, the joined Intervention of physicians and pharmacists optimized outcomes and promoted self-management of patients in home settings. This study supports the feasibility of integrating the internet into self-management of cancer pain patients.
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