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They are usually developed by therapeutic committees and they list the drugs that are approved for use in that country cialis black 800 mg generic, region purchase cialis black 800mg mastercard, district or hospital order cialis black master card. In many countries drug formularies are also developed for health insurance programmes cialis black 800 mg, listing the products that are reimbursed. Their value is enhanced if they contain comparisons between drugs, evaluations and cost information, but that is often not the case. Drug bulletins These periodicals promote rational drug therapy and appear at frequent intervals, ranging from weekly to quarterly. Drug bulletins can be a critical source of information in helping prescribers to determine the relative merits of new drugs and in keeping up-to-date. Drug bulletins can have a variety of sponsors, such as government agencies, professional bodies, university departments, philanthropic foundations and consumer organizations. They are published in many countries, are often free of charge, and are highly respected because of their unbiased information. A good independent drug bulletin in French is Prescrire; it is not free of charge. National drug bulletins are appearing in an increasing number of developing countries, which include Bolivia, Cameroon, Malawi, the Philippines and Zimbabwe. The main advantages of national drug bulletins are that they can select topics of national relevance and use the national language. Medical journals Some medical journals are general, such as The Lancet, the New England Journal of Medicine or the British Medical Journal; others are more specialized. The specialized journals include more detailed information on drug therapy for specific diseases. You can usually check whether journals meet this important criterion by reading the published instructions for submission of articles. They are usually glossy and often present information in an easily digestible format. They can be characterized as: free of charge, carrying more advertisements than text, not published by professional bodies, not publishing original work, variably subject to peer review, and deficient in critical editorials and correspondence. They sometimes report on commercially sponsored conferences; in fact, the whole supplement may be sponsored. Only a relatively small proportion publish scientifically validated, peer reviewed articles. If in doubt about the scientific value of a journal, verify its sponsors, consult senior colleagues, and check whether it is included in the Index Medicus, which covers all major reputable journals. Verbal information Another way to keep up-to-date is by drawing on the knowledge of specialists, colleagues, pharmacists or pharmacologists, informally or in a more structured way through postgraduate training courses or participation in therapeutic committees. Community based committees typically consist of general practitioners and one or more pharmacists. In a hospital setting they may include several specialists, a clinical pharmacologist and/or a clinical pharmacist. Using a clinical specialist as the first source of information may not be ideal when you are a primary health care physician. In many instances the knowledge of specialists may not really be applicable to your patients. Some of the diagnostic tools or more sophisticated drugs may not be available, or needed, at that level of care. Drug information centres Some countries have drug information centres, often linked to poison information centres. Health workers, and sometimes the general public, can call and get help with questions concerning drug use, intoxications, etc. Many major reference data bases, such as Martindale and Meylers Side Effects of Drugs, are now directly accessible 89 Guide to Good Prescribing through international electronic networks. Cartoon 5 When drug information centres are run by the pharmaceutical department of the ministry of health, the information is usually drug focused. Centres located in teaching hospitals or universities may be more drug problem or clinically oriented. Computerized information Computerized drug information systems that maintain medication profiles for every patient have been developed. Some of these systems are quite sophisticated and include modules to identify drug interactions or contraindications. Some systems include a formulary for every diagnosis, presenting the prescriber with a number of indicated drugs from which to choose, including dosage schedule and quantity. If this is done, regular updating is needed using the sources of information described here. In many parts of the world access to the hardware and software needed for this technology will remain beyond the reach of individual prescribers. In countries where such technology is easily accessible it can make a useful contribution to prescribing practice. However, such systems cannot replace informed prescriber choice, tailored to meet the needs of individual patients. Pharmaceutical industry sources of information Information from the pharmaceutical industry is usually readily available through all channels of communication: verbal, written and computerized. Industry promotion budgets are large and the information produced is invariably attractive and easy to digest. However, commercial sources of information often emphasize only the positive aspects of products and overlook or give little coverage to the negative aspects. This should be no surprise, as the primary goal of the information is to promote a particular product. This means that the information is provided through a number of media: medical representatives (detail men/women), stands at professional meetings, advertising in journals and direct mailing. Often over 50% of the promotional budget of pharmaceutical companies in industrialized countries is spent on representatives. Studies from a number of countries have shown that over 90% of physicians see representatives, and a substantial percentage rely heavily on them as sources of information about therapeutics. However, the literature also shows that the more reliant doctors are on commercial sources of information only, the less adequate they are as prescribers. In deciding whether or not to use the services of drug representatives to update your knowledge on drugs, you should compare the potential benefits with those of spending the same time reading objective comparative information. If you do decide to see representatives, there are ways to optimize the time you spend with them. Take control of the discussion at the outset so that you get the information you need about the drug, including its cost. If your country has a health insurance scheme, check whether the drug is included in the list of reimbursable products. Early on in the discussion ask the representative to give you a copy of the officially registered drug information (data sheet) on the product under discussion, and during the presentation compare the verbal statements with those in the official text. Even before reading these, the quality of the journals in which they appear will be a strong indication of the likely quality of the study. You should know that the majority of newly marketed drugs do not represent true therapeutic advances but are what is known as ‘me too’ products. In other words, they are very similar in chemical composition and action to other products on the market. The difference is usually in price; the most recently marketed drug is usually the most expensive! Seeing medical representatives can be useful to learn what is new, but the information should always be verified and compared with impartial, comparative sources. Drug information from commercial sources is also issued as news reports, and as scientific articles in professional journals. A number of countries and professional associations are tightening regulations controlling drug promotion to tackle this problem. Some journals now require that any sponsorship from the pharmaceutical industry should be mentioned in the article. As mentioned above and as studies show, it is not good practice to use only commercial information to keep up-to-date. Although it may seem an easy way 91 Guide to Good Prescribing to gather information, this source is often biased towards certain products and is likely to result in irrational prescribing. This is particularly true for countries without an effective regulatory agency, because more drugs of sometimes doubtful efficacy may be available and there may be little control on the contents of data-sheets and advertisements. The International Federation of Pharmaceutical Manufacturers’ Associations also has a code of pharmaceutical marketing practices.

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European seizures consumption also occurs in neighbouring Slovakia discount 800 mg cialis black visa, some accounted for almost 80% of the world total buy discount cialis black 800mg online. Illicit drug use In contrast to other regions generic cialis black 800 mg, non-medical use of pre- scription drugs has not been regarded as a major prob- The most prevalent drug in Europe is cannabis order generic cialis black on-line, showing 32 lem in Europe so far. Around 18% of the total canna- non-medical use of prescription opioids than heroin. Following years of The highest levels of non-medical use of prescription significant increases, cannabis use appears to have stabi- opioids so far have been reported from Northern Ireland lized in Europe. Other countries in Europe reporting a substantial Cocaine is the second most prevalent drug (0. In % of global 2005 2006 2007 2008 2009 total in 2009 Cannabis resin 907,423 618,448 853,654 937,027 623,369 49% Cannabis herb 105,577 132,558 144,310 178,345 198,841 3% Cocaine 106,587 121,065 79,864 62,737 56,736 8% Amphetamines-group 9,906 11,434 11,216 9,771 9,077 14% of which amphetamine 8,039 6,019 8,791 9,438 8,117 24% Ecstasy 4,709 5,649 5,839 1,763 995 18% Heroin 22,165 22,171 26,394 29,206 28,762 38% Opium 2,059 1,292 1,445 1,324 1,379 0. Khat is not under international control, though a drug users all across Europe, including substitution number of countries – including countries in Africa – treatment clients. Studies show that between 11% and 33 have introduced national legislation to prohibit its cul- 70% of clients report current use of benzodiazepines. Drug-related deaths Trafficking For Europe, the best estimates suggest that there are Most of the cannabis trafficking is for shipments across between 25,000 and 27,000 drug-related deaths annu- African countries. Only smaller amounts are destined ally, with a rate between 46 and 48 deaths per one mil- for overseas markets, mainly in Europe. Most of the can- lion people aged 15-64, though some estimates give nabis resin production in North Africa is for final con- substantially higher figures (about twice these numbers). The largest seizures were reported Drug-related deaths due to overdose amounted to some for cannabis herb, followed by cannabis resin. Africa’s 7,000 in the countries of the European Union in recent 34 share of global cannabis herb seizures amounts to 11% years, down from around 8,000 in 2000. Opioids, – and is thus below its share of the global population mainly heroin, are predominantly ranked as the primary (15%), while its share in global cannabis resin seizures cause of death, followed – at much lower levels – by – mostly carried out by countries in North Africa – is cocaine. Combined, these five countries Africa has been affected by significant shipments of account for some 80% of all reported drug-related cocaine from South America to Europe in recent years. In terms of mortality rates, Ukraine, The amounts trafficked via Africa to Europe, however, Iceland, Ireland and Luxembourg seem to experience seem to have decreased in 2008 and 2009, and only some of the highest levels in Europe, with over 100 partly resumed in 2010. Estimates for 2009 suggest that drug-related deaths per one million inhabitants aged some 35 mt of cocaine may have left South America for 15-64. Illicit drug production in Africa is mainly focused on In addition, African countries are increasingly being used cannabis. While cannabis resin is mainly produced in by traffickers to ship Afghan heroin to final destinations Morocco, cannabis herb is produced all over Africa. Though East Africa is Small-scale opium production is limited to countries in reportedly the main intermediate target for these traf- North Africa, notably Egypt, which regularly reports the ficking activities, African heroin seizures were highest in largest eradication of opium poppy among all countries Southern Africa and North Africa. For some time, methamphetamine and Methamphetamine seizures have been reported from methcathinone production has been taking place in Nigeria and South Africa. The paucity of the data does not allow for a reliable characterization for the continent In contrast, recent reports of shipments of metham- as a whole. In % of global 2005 2006 2007 2008 2009 total in 2009 Cannabis herb 865,974 1,220,578 694,177 936,084 639,769 11% Cannabis resin 121,576 132,784 140,544 165,455 320,600 25% Khat* 1,522 5,691 2,490 6,219 23,442 12% Cocaine 2,575 851 5,535 2,551 956 0. The available information that drug-related death in Africa is close to the global suggests that cannabis use is widespread, and that other average. Estimates could of course change substantially drugs are used as well, notably in urban areas. The limited information on drug-related treatment in e) Asia Africa identified cannabis as the main problem drug, accounting for 64% of all treatment demand in the Production region. This is a far higher proportion for cannabis than The main illicit drug produced in Asia is opium. Though the proportion of Asian opium khat (3%), solvents and inhalants (3%) and sedatives production in the global total declined from 98% in and tranquillizers (2%). While Afghan opium production declined over medical prescription drug use in the region. However, the 2007-2010 period, production in Myanmar parallel markets exist in many African countries, where increased. In Mada- ment of Afghanistan cannabis survey found cannabis gascar, around 38% of the total treatment demand was resin production of 1,200-3,700 mt in Afghanistan in for tranquillizers, second to cannabis (>60%). Similarly 2010, and Afghanistan was worldwide the second most in South Africa, on average 6. Metham- could be between 13,000 and 41,700 drug-related phetamine manufacture is mainly concentrated in East deaths, equivalent to between 23 and 74 per one million and South-East Asia, including the Philippines, China, Malaysia and Myanmar. Limited production of ecstasy also (mainly Captagon) happen primarily in the Near and takes place in Asia, notably East and South-East Asia, Middle East, notably the Arabian peninsula, accounting including Malaysia, China and Indonesia. Both amphetamine and methamphetamine seizures increased in Asia over the 2005-2009 period (by Trafficking 59% and 36%, respectively). Trafficking in Asia is dominated by opium and heroin, Ecstasy seizures, in contrast, declined over the 2005- which are smuggled to final destinations within the 2009 period (-58%), which is also in line with reports region as well as to Europe (from Afghanistan) and China (from Myanmar), though some Afghan opiates of improved ecstasy precursor controls. The importance also find their way to China (up to 30% of Chinese of Asian ecstasy seizures in the global total (9%) is much demand). Similarly, morphine A problem, for countries in East and South-East Asia as seizures made in Asia accounted for more than 99% of well as South Asia, is the increasing popularity of keta- the world total. More than half of all heroin seizures mine, a drug used mainly in veterinary medicine for its (56% in 2009) were made by Asian countries. It is not under international con- with the much larger opium production of Afghanistan trol. Seizures of ketamine tripled over the larger for the countries surrounding Afghanistan (nota- 2005-2009 period and were in 2009 – in volume terms bly the Islamic Republic of Iran and Pakistan) than for – some 20 times larger than ecstasy seizures in Asia. Cannabis herb seizures in Asia amounted to just 6% of Most of the ketamine is produced in the region. In contrast, cannabis resin seizures accounted for 24% of the world total in 2009. Cannabis Cocaine seizures reported in Asia accounted for just herb and resin seizures in Asia both showed upward 0. Nonetheless, except for coun- trends over the 2005-2009 period (60% and 30%, tries in Central Asia, all other subregions reported sei- respectively). Relative concentrations nabis resin seizures in 2009 took place in the Near and of cocaine trafficking seem to exist in East and South- Middle East/South-West Asia. In % of 2005 2006 2007 2008 2009 global total in 2009 Opium 337,071 381,741 517,119 643,873 649,449 > 99% Morphine 31,342 45,787 27,039 17,060 23,655 > 99% Heroin 31,852 30,442 34,699 40,490 42,512 56% Cannabis herb 233,808 231,786 201,030 331,322 373,522 6% Cannabis resin 236,284 227,822 308,410 543,177 306,556 24% Amphetamines-group 29,968 32,460 31,031 32,854 41,592 64% of which amphetamine 15,572 15,690 19,296 19,711 24,772 74% methamphetamine 12,175 12,360 11,026 13,052 16,577 53% Ecstasy 1,202 451 1,998 843 506 9% Ketamine 3,256 4,455 12,098 7,913 10,693 99% Cocaine 525 711 568 1,136 676 0. Increased use of synthetic and pre- Despite national differences, overall cannabis use is, scription drugs has also been reported in a number of however, rather low in Asia, clearly below the global countries, including Jordan, Qatar and the United Arab average. In Kuwait, for instance, around 16% of treat- istan and Lebanon and their respective neighbouring ment demand was related to the use of sedatives and countries, cannabis herb is mainly used in South and tranquillizers. Drug-related deaths The second most widely consumed drug type in Asia is Asia has the largest uncertainty in the estimated range of the amphetamines, that is, methamphetamine in East drug-related deaths: between 6 and 51 deaths per one and South-East Asia and amphetamine on the Arabian million persons aged 15-64. Available information suggests that the use of with caution, considering the lower coverage and report- amphetamines increased in recent years. Nevertheless, due to the consider- Asian countries reported mixed trends of ecstasy use. By far the most problematic group of substances for f) Oceania most Asian countries are the opiates. It is estimated that more than half of the world’s opiate-using population Production lives in Asia. Opiate prevalence rates are particularly Drug production in Oceania is limited to the cultivation high in the main opium-producing regions as well as in of the cannabis plant, mainly for the production of can- some of their neighbouring countries. Cannabis production takes place in Aus- mates of opiate consumption are found in the countries tralia, New Zealand and most of the small island of South-West Asia. Cannabis production is for local consump- Cocaine use in Asia is still limited, though there are tion and there is no information on exports to other regular reports that organized crime groups are trying to regions. This is mainly metham- Due to the absence of regular prevalence studies for the phetamine and, to a lesser extent, ecstasy. In addition, majority of countries in Asia, information on non-med- some amphetamine is also produced. The amounts of drugs seized in Oceania tend to be very In Bangladesh, Nepal and India, buprenorphine is com- small by international standards. In South-West and Central Asia, among herb continued to decline over the 2005-2009 period the regular heroin users, the non-medical use of pre- and account for just 0.

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Prayer, meditation, and sharing can help us get outside ourselves to focus on something beyond our own discomfort. Identifying yourself as a recovering addict to healthcare professionals may be helpful. Talk to your healthcare provider and sponsor before taking prescription or nonprescription medication. When supporting a member living with illness, remember that they need our unconditional love, not our pity or judgment. Continue on your path of recovery in Narcotics Anonymous by applying spiritual principles. Ideal for reading on a daily basis, these thoughts provide addicts with the perspective of clean living to face each new day. This introductory pamphlet helps provide an understanding of sponsorship, especially for new members. This book includes a section in Chapter Four that highlights how a sponsor can be a valuable source of guidance and support when facing an illness in recovery. The second half of the pamphlet, “The Twelve Steps Are the Solution,” outlines the process that allows recovering addicts to apply the Twelve Steps in every area of their lives in order to gain acceptance of themselves and others. More Will Be Revealed (Basic Text, Chapter 10) This chapter contains a variety of recovery related topics. Oral Oncology Medication Toolkit Overview for Health Care Providers When prescribing oral oncology medications, the framework and continuum of patient care may be considerably different from other forms of oncology treatment options. In this toolkit, various educational pieces as well as support resources are provided both in the form of provider-facing and patient-facing materials, as listed below. Specifically, the types of support resources provided throughout the toolkit include: fact sheets, checklists, question guides, flowsheet, and treatment calendar. While each organization’s setup and patient populations may be different, note that this toolkit is only intended to provide general considerations in navigating patient care with oral oncology medications. Table of Contents Health Care Provider Education This resource provides a general framework of review Considerations to Conduct Organizational AssessmentComponents of an Oral Oncology Program Question Guide Given the estimated growth of oral oncology treatments, establishing the necessary infrastructure to support a comprehensiveQuestion Guide questions that are in line with a core set of key a general framework of review questions that are in line with a core set of components that are key to managing patienttherapy with oral oncology medications. Specifically, this resource may be helpful to organizations that will need to conductoral oncology program is important towards maintaining a clear course of patient care. To assist, this resource provides Components of an Oral processes of an existing oral oncology program. It may be helpful either to • Conducting baseline patient readiness assessments to evaluate if patients are appropriate candidatesAssessment, as a core component of oral oncology management, involves:for therapy with oral oncology medications Considerations to Conduct Assessment organizations that will need to conduct a readiness • Conducting financial review of patient access to insurance or other assistance programs, includingAccess, as a core component of oral oncology management, involves:identifying support resources Organizational Assessment • Understanding the methods of acquiring oral oncology medications, most commonly through anin-house dispensing pharmacy or specialty pharmacy, including the specific considerations for eachroute of access Access Treatment plan, as a core component of oral oncology management, involves: assessment toward developing a new oral oncology • Conducting comprehensive review of the patient’s medical care with oral oncology medications,including informed consent, obtaining clinical history, performing clinical evaluations and review,and developing a monitoring adherence plan, among other considerations Treatment Plan Communication, as a core component of oral oncology management, involves: program, or to organizations that are looking to refine the • At a practice level, ensuring effective and coordinated communication among all providers who arepart of a patient’s health care team Communication • At a patient level, understanding when and how to communicate with the health care team, includingmanaging side effects, among other considerationsissues related to correctly administering the oral oncology medication, monitoring adherence, and processes of an existing oral oncology program. While the structure and dynamics of each organization isdifferent, in this resource, sample considerations related to navigating a core set of components that are key to managingWhen prescribing therapy with an oral oncology medication, the processes and flow of patient care is different compared to navigating a core set of key components for managing patient therapy with oral oncology medications are reviewed. Operations, as a core component of oral oncology management, involves: Process Flowsheet Care Plan • Managing flow patterns and operational processes specific to treating a patient who is prescribedwith oral oncology medications throughout the care continuum, from treatment planning and financialreview through medication acquisition and educational training patient therapy with oral oncology medications. Operations Oral Oncology Medication • Conducting baseline patient readiness assessments to evaluate if patients are appropriate candidatesAssessment, as a core component of oral oncology management, involves:for therapy with oral oncology medications Assessment Therapy Management • Conducting financial review of patient access to insurance or other assistance programs, includingAccess, as a core component of oral oncology management, involves:identifying support resources Access • Understanding the methods of acquiring oral oncology medications, most commonly through anroute of accessin-house dispensing pharmacy or specialty pharmacy, including the specific considerations for each • Conducting comprehensive review of the patient’s medical care with oral oncology medications,Treatment plan, as a core component of oral oncology management, involves:including informed consent, obtaining clinical history, performing clinical evaluations and review, and developing a monitoring adherence plan, among other considerations Treatment Plan • At a practice level, ensuring effective and coordinated communication among all providers who areCommunication, as a core component of oral oncology management, involves:part of a patient’s health care team Communication • At a patient level, understanding when and how to communicate with the health care team, includingmanaging side effects, among other considerationsissues related to correctly administering the oral oncology medication, monitoring adherence, and Education, as a core component of oral oncology management, involves:• At a practice level, establishing an educational program and developing a curriculum as needed • At a patient level, receiving educational training related to therapy with oral oncology medications EducationEducation This resource provides an overview of the benefits and Medication Acquisition:& Specialty Pharmacy In-House Dispensing Pharmacy Know the Facts When prescribing oral oncology medications, acquisition methods for patients typically involve obtaining the treatmentKnow the Facts challenges of in-house dispensing pharmacies and challenges as well as considerations for each method are reviewed. Support point-of-care dispensing and be willing to discuss with each patient the opportunity to obtain his or herprescribed medicationsIn-House Dispensing Pharmacy Medication Acquisition: specialty pharmacies, as well as considerations for each for Health CareConsiderationsProviders & 3. Dispense oral oncology medications in an area of the office that is mindful of patient flow and individual2. Plan for point-of-care dispensing and devote the necessary time to successfully train all personnelstate requirements Staff 5. Collect prescription drug benefit information on all patients as a routine part of patient check-in4. Stock all medications generally required by patients as well as be mindful of volumes and averages • Is convenient and is housed inside of oncology officesBenefits1 • Varying levels of physician supervision may Challenges1 In-House Dispensing Pharmacy method of distribution. Case managers know when patients receive their medications and can educate patients at the outsetabout the course of therapy, side effects, and dosing scheduleSpecialty Pharmacy Stafffor Health CareProviders & 3. Physicians receive regular e-mails and phone calls from case managers regarding their patients taking oral2. Medication therapy management service informs case managers when to be on the lookout for specific toxicitiesand other issues that clinical trials and other patient experiences have made apparent oncology medicationsBenefits1 Challenges1 Specialty • Delivers medication to patient at no additional costs• Likely able to custom pack doses • Provides additional patient education by phone or mailto avoid multiple • Potential challenge with communication about patient care between the specialty pharmacy and oncologypractice Pharmacy • Works closely with various insurance plans• Has access to patient assistance programscopayments • Specialty pharmacy may not be local• Patients may have concerns about working with a pharmacy by phone References:1. Adherence to oral therapies for cancer: helping your patients stay on course toolkit. Behind Closed Network Doors: Oral Cancer Drugs and the Rise of Specialty Pharmacy. To assist, this resource provides a general framework of review questions that are in line with a core set of key components for managing patient therapy with oral oncology medications. Specifically, this resource may be helpful to organizations that will need to conduct a readiness assessment toward developing a new oral oncology program, or to organizations that are looking to refine the processes of an existing program. Operations, as a core component of oral oncology management, involves: • Managing flow patterns and operational processes specific to treating a patient who is prescribed oral oncology medications throughout the care continuum, from treatment planning and financial review through medication acquisition and educational training Operations Assessment, as a core component of oral oncology management, involves: • Conducting baseline patient readiness assessments to evaluate if patients are appropriate candidates for therapy with oral oncology medications Assessment Access, as a core component of oral oncology management, involves: • Conducting financial review of patient access to insurance or other assistance programs, including identifying support resources • Understanding the methods of acquiring oral oncology medications, most commonly through an in-house dispensing pharmacy or specialty pharmacy, including the specific considerations for each Access route of access Treatment plan, as a core component of oral oncology management, involves: • Conducting comprehensive review of the patient’s medical care with oral oncology medications, including informed consent, obtaining clinical history, performing clinical evaluations and review, and developing an adherence plan, among other considerations Treatment Plan Communication, as a core component of oral oncology management, involves: • At a practice level, ensuring effective and coordinated communication among all providers who are part of a patient’s health care team • At a patient level, understanding when and how to communicate with the health care team, including issues related to correctly administering the oral oncology medication, monitoring adherence, and Communication managing side effects, among other considerations Education, as a core component of oral oncology management, involves: • At a practice level, establishing an educational program and developing a curriculum as needed • At a patient level, receiving educational training related to therapy with oral oncology medications EducationEducation Operations Questions for the organization to review internally 1. What are your current patterns of patient-flow with intravenous oncology treatments and how do you think the integration of orals will impact these patterns? Where and when along the patient flow of care do you think issues may arise with patients taking oral oncology medications? Specifically, what do you anticipate these issues will be and how will you plan to address them? Who within the organization will be responsible for leading the overall effort to develop new or refine existing processes related to the oral oncology program? How do you anticipate staff roles changing with the implementation of an oral oncology program? Who within the organization will be responsible for leading financial assessments and counseling for patients who are prescribed oral oncology medications? How will patients be able to obtain their oral oncology medications (eg, through specialty pharmacy or in-house dispensing)? If considering dispensing through in-house pharmacy, what will your organization need to review in terms of requirements (eg, stocking specialized items, credentialing with insurers, assessing if payers allow refills, complying with state regulations) and who will be responsible for leading this effort? If considering routing through specialty pharmacy, what coordination of care and communication processes will your organization and specialty pharmacy establish (eg, monitoring and communicating patient adherence, tracking patient refills, notifying dose changes) and who will be responsible for leading this effort? Who within the organization will be responsible for developing the treatment plan specific to oral oncology medications? What type of information will be included in a patient’s oral oncology treatment plan and how may this be different from an intravenous oncology treatment plan? What plans will your organization have in place to update current policies and procedures to integrate oral oncology medications; who will be responsible for leading this effort, and how will this be communicated within your practice? How will patients be able to communicate with your organization and report issues with taking their oral oncology medications should they arise (eg, adherence, side effects, toxicity/safety concerns) 3. How does your organization anticipate that physician communication will change with the patients who are prescribed therapy with oral oncology medications and what type of training can your practice offer to address communication changes? How will your organization communicate with other providers who are part of your patient’s health care team (eg, primary care physicians, specialists, specialty pharmacy)? How will your organization support caregivers during a patient’s course of treatment with oral oncology medications? How will your organization manage patient adherence and monitoring with oral oncology medications and what level of support will be offered?

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