Outcomes of Telepharmacy Services Combined with Medication Delivery by Mail in Breast Cancer Patients
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Abstract
Medication knowledge and continuity of endocrine therapy are critical determinants of treatment outcomes in breast cancer. The integration of telepharmacy services with mailed medication delivery has been proposed as a strategy to enhance access to pharmaceutical care and mitigate travel-related barriers. Objective: To evaluate medication knowledge, drug-related problems (DRPs), medication adherence, patient satisfaction, and economic savings resulting from the integration of telepharmacy services and mail-order medication among breast cancer patients receiving endocrine therapy. Methods: A prospective quasi-experimental study was conducted at Khon Kaen Hospital from March 31 to December 31, 2025. Eighty-five patients receiving endocrine therapy were enrolled in a telepharmacy program integrated with mail medication delivery under the Medically Integrated Dispensing (MID) framework. Medication knowledge was assessed using a five-item structured test. Medication adherence was quantified using the Modified Medication Possession Ratio (mMPR). Patient satisfaction was evaluated using a five-point Likert scale, and travel-related expenditures were recorded. The Wilcoxon signed-rank test and descriptive statistics were used to analyze the data, with a two-tailed significance level set at p<0.05. Results: All participants were female (n = 85), with a mean age of 58.11 ± 9.72 years. Tamoxifen was the most frequently prescribed medication (57.65%). Post-program analysis demonstrated a statistically significant increase in median knowledge scores, from 4 to 5 (p< 0.05). DRPs were identified in 41.18% of patients, with hot flashes being the most common reported issue (24.71%). Mean mMPR was 97.36%, exceeding the predefined adherence threshold of 80%. Satisfaction scores were consistently high (mean range: 4.65–4.88). The intervention was associated with a mean reduction in travel costs of 496.06 ± 431.52 THB per visit. Conclusion: The integration of telepharmacy services with mailed medication delivery was associated with improved medication knowledge, high levels of adherence, high patient satisfaction, and reduced travel-related financial burden among breast cancer patients receiving endocrine therapy.
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References
Dillmon MS, Kennedy EB, Anderson MK, et al. Patient-centered standards for medically integrated dispensing: ASCO/NCODA standards. J Clin Oncol. 2020;38(6):633-44. Available from: http://dx.doi.org/10.1200/JCO.19.02297.
Faculty of Medicine Siriraj Hospital. Siriraj advancement project: nationwide medication delivery via post office [Internet]. 2015 Jan 27 [cited 2024 Sep 15]. Available from: https://www.si.mahidol.ac.th/th/division/um/admin/download_files/230_48_1gbXlaZ.pdf.
Hershman DL, Shao T, Kushi LH, et al. Early discontinuation and non-adherence to adjuvant hormonal therapy are associated with increased mortality in women with breast cancer. Breast Cancer Res Treat. 2011;126(2):529-37.
ISOPP. ISOPP standards for the safe handling of cytotoxics. J Oncol Pharm Pract. 2022;28(3 Suppl):S1-S126.
Loibl S, André F, Bachelot T, et al. Early breast cancer: ESMO clinical practice guideline for diagnosis, treatment and follow-up. Ann Oncol. 2024;35(2):159-82.
Makubate B, Donnan PT, Dewar JA, Thompson AM, McCowan C. Cohort study of adherence to adjuvant endocrine therapy, breast cancer recurrence and mortality. Br J Cancer. 2013;108(7):1515-24.
Marsden E, Torgerson CJ. Single group, pre- and post-test research designs: some methodological concerns. Oxf Rev Educ. 2012;38(5):583-616.
National Cancer Institute (Thailand). Cancer registry [Internet]. NCI.go.th [cited 2024 Sep 15]. Available from: https://www.nci.go.th/th/cancer_record/download/Hosbased-2022-1.pdf.
Nguyen OT, Mason A, Charles D, et al. Patient and caregiver experience with telepharmacy in cancer care to support beginning systemic therapy: a qualitative study. J Oncol Pharm Pract. 2024;30(3):442-50. Available from: http://dx.doi.org/10.1177/10781552231181911.
Niznik JD, He H, Kane-Gill SL. Impact of clinical pharmacist services delivered via telemedicine in the outpatient or ambulatory care setting: a systematic review. Res Social Adm Pharm. 2018;14(8):707-17.
Pharmaceutical Care Network Europe. DRP-classification V9 [Online]. 2020 [cited 2024 Sep 15]. Available from: https://www.pcne.org/upload/files/411_20200504_Final_Report_online_validation_PCNE_classification.pdf.
Shadish WR, Cook TD, Campbell DT. Experimental and quasi-experimental designs for generalized causal inference. Boston: Houghton Mifflin; 2002.
Soonthorn S, Ngamkham S, Tanglakmankhong K, et al. The evaluation of the mailed-order medication system for patients with diabetes mellitus during the COVID-19 pandemic in Thailand [Internet]. 2022 [cited 2024 Sep 15]. Available from: https://kb.hsri.or.th/dspace/handle/11228/5769?locale-attribute=th.
Wangwatcharakul W, Kapol N, Bunchuailua W. The effectiveness of telemedicine for breast cancer disease management: a systematic review and meta-analysis. Thai Bull Pharm Sci. 2018;13(2):145-61.
Warathanakul W. Outcomes of the implementation of Health Riders and mail services to deliver medications to patients with telepharmacy in patients with chronic diseases at Vachiraphuket Hospital. Thai J Pharm Pract. 2025;17(4):1010-29.
WHO. Drug and therapeutics committee training course [Online]. 2020 [cited 2024 Sep 15]. Available from: https://www.who.int/medicines/technical_briefing/tbs/04-PG_Dug-Safety_final-08.
Yussof I, Mohd Tahir NA, Hatah E, Mohamed Shah N. Factors influencing five-year adherence to adjuvant endocrine therapy in breast cancer patients: a systematic review. Breast. 2022;62:22-35.
