Feasibility of Medication Coordination With Lay Navigators in Outpatient Oncology Clinics

Background Significant obstacles exist with approval and payment of oncology medications for both the patient and the pharmacy team. Our medication assistance program is supported by the clinical pharmacist (CP) and clinic staff. Many tasks are time consuming, interrupt patient care, and may create medication access delays. Patients also need assistance with health insurance literacy and have minimal understanding of medication assistance resources. Lay navigators (LN) are volunteers who assist cancer patients to overcome barriers to care. They are trained to work in tandem with clinical staff while linking patients to financial resources. A pilot was developed to determine the feasibility and value of integrating LN support within the pharmacy team.

Methods Four LNs were integrated into oncology clinics. Tasks were assigned to the LN under the supervision of the CP. The LN documented tasks executed, entities, and patients they communicated with and time spent on each encounter.

Results From April to June 2018, 4 LNs were available 2 to 4 hours per week. The LN completed 56 interventions for 20 patients (Table 1). Average time spent on each intervention was 19 minutes. Over the 9-week pilot period the LN saved clinic staff a total of 10.87 hours. LN survey feedback was positive, and 75% of the LNs report confidence when communicating with patients about medication access.

TABLE 1

Intervention	%
Communicate with patient about access issues by telephone	33.9
Alleviate delays in medication access from specialty pharmacy, manufacturer, or insurance	32.1
Facilitate manufacture and co-pay assistance	12.5
Coordinate prior authorization requests	3.6

Conclusions We have demonstrated that LNs can be utilized as a pharmacy advocate for medication coordination in oncology clinics at our academic medical center. LN satisfaction was high and time savings allowed CP to focus on direct patient care. The model is cost effective and requires few resources other than financial toxicity training and supervision. Future steps will include determining financial impact, patient satisfaction, and expansion into additional clinics.