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Cavalcante-Santos LM, Guarnieri AC, Conegundes FSDL, Giardini MH, Pereira LRL, Varallo FR. Clinical pharmacy in hospital palliative medicine: non-randomised clinical trial. BMJ Support Palliat Care 2023:spcare-2023-004620. [PMID: 38129106 DOI: 10.1136/spcare-2023-004620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To assess the impact of pharmaceutical care on hospital indicators and clinical outcomes of palliative care (PC) patients admitted to a secondary hospital. METHODS A non-randomised clinical trial was carried out in the PC ward of a secondary hospital in São Paulo, Brazil. Pharmaceutical care for all patients aged 18 and above, admitted between October 2021 and March 2022, with stays exceeding 48 hours, was provided. The interventions required were performed in collaboration with healthcare teams, patients and caregivers. Assessments occurred at admission and discharge, using PC performance scales and pharmacotherapy tools, with Research Ethics Committee approval. RESULTS Over 6 months, 120 hospitalisations were analysed, primarily involving women (58.9%), averaging 71.0 years, with neoplasm diagnoses (20.5%). A total of 170 drug-related problems were identified in 68.3% of patients. Following assessment, 361 interventions were performed, with a 78.1% acceptance rate, including medication dose adjustments, additions and discontinuations. Addressing unintentional pharmacotherapy discrepancies at admission led to reduced hospital stays (p<0.05). Pharmaceutical interventions also decreased pharmacotherapy complexity (p<0.001), inappropriate medications for the older people (p<0.001) and improved symptom management, such as pain (p<0.05). CONCLUSIONS Pharmaceutical care services integrated within the multiprofessional health team contributed to reducing drug-related problems associated with polypharmacy as well as improved the management PC symptoms in end-of-life patients, which reduced hospitalisation time.
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Affiliation(s)
- Lincoln Marques Cavalcante-Santos
- Department of Pharmaceutical Sciences, Pharmaceutical Care and Clinical Pharmacy Research Center, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Ana Carolina Guarnieri
- Department of Pharmaceutical Sciences, Pharmaceutical Care and Clinical Pharmacy Research Center, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Fernanda Silva de Lima Conegundes
- Department of Pharmaceutical Sciences, Pharmaceutical Care and Clinical Pharmacy Research Center, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | | | - Leonardo Régis Leira Pereira
- Department of Pharmaceutical Sciences, Pharmaceutical Care and Clinical Pharmacy Research Center, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Fabiana Rossi Varallo
- Department of Pharmaceutical Sciences, Pharmaceutical Care and Clinical Pharmacy Research Center, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
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Atayee RS, Edmonds KP. A Specialist Palliative Pharmacist Enriches the Interdisciplinary Team: A Case Series Discussion Illustrating the Entrustable Professional Activities for Specialist Hospice and Palliative Care Pharmacists. J Palliat Med 2023; 26:1755-1758. [PMID: 37358818 DOI: 10.1089/jpm.2023.0186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023] Open
Abstract
Introduction: Palliative care (PC) pharmacists are an integral member of the PC team. Essential roles have been defined and entrustable professional activities (EPAs) have been recently developed for hospice and PC pharmacists. Case Description: We review four different complex patient cases where the specialist PC pharmacist worked with the interdisciplinary team to address whole patient suffering. Through the case series, we highlight the various components of HAPC pharmacist EPAs across the continuum of care. Case Management, Outcome, and Conclusion: Through the case series discussion, we brought to light PC pharmacists' EPAs in pharmacotherapy consultation, assessing and optimizing medication therapy, symptom management, deprescribing, participating in goals-of-care discussions, managing medication therapy in the withdrawal of life-sustaining therapy in collaboration with interdisciplinary team in alignment with patient and family values, prognosis, and plan of care. We also emphasized the importance of PC pharmacists contributing to the advancement of science.
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Affiliation(s)
- Rabia S Atayee
- Palliative Care Program, University of California, San Diego, San Diego, California, USA
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, UC San Diego Section of Palliative Care, La Jolla, California, USA
- San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, California, USA
- Department of Pharmacy, University of California Health, La Jolla, California, USA
| | - Kyle P Edmonds
- Palliative Care Program, University of California, San Diego, San Diego, California, USA
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, UC San Diego Section of Palliative Care, La Jolla, California, USA
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Alshehri AM, Almogbel YS, Alonazi RE, Alshehri WM, Alkhelaifi HA, Almutairi SA, Alenazi OS, Alali AZ. Pharmacists' Knowledge and Intention to Provide Palliative Care Services in Saudi Arabia: Using the Theory of Planned Behaviour. Healthcare (Basel) 2023; 11:2173. [PMID: 37570413 PMCID: PMC10418381 DOI: 10.3390/healthcare11152173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/17/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
Providing palliative care to patients with life-threatening illnesses requires multidisciplinary efforts from different healthcare providers. Identifying the attitude, knowledge, and intentions of pharmacists to provide this service in Saudi Arabia is essential. Therefore, this study aimed to identify the palliative care knowledge, intentions, attitudes, subjective norms, and perceived behavioural control of pharmacists and what factors predict their intentions. Cross-sectional questionnaires based on the theory of planned behaviour were distributed to pharmacists in hospitals and community pharmacies. They included items that measured palliative care knowledge, attitudes, intentions, subjective norms, and the perceived behavioural control of pharmacists and identified other sociodemographic and pharmacy-practice-related items. In total, 131 pharmacists completed the questionnaires, showing an average score on palliative knowledge (8.82 ± 1.96; range: 1-14), strong intentions (5.84 ± 1.41; range: 1-7), positive attitudes (6.10 ± 1.47; range: 1-7), positive subjective norms (5.31 ± 1.32; range: 1-7), and positive perceived behavioural control (5.04 ± 1.21; range: 1-7). Having completed a pharmacy residency program, working longer hours per week, having a more positive attitude, and perceived stronger subjective norms were significantly associated with a strong intention to provide palliative care services. Therefore, enabling and motivating pharmacists to complete pharmacy residency programs and improve their attitudes could increase their intentions to provide these services.
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Affiliation(s)
- Ahmed M. Alshehri
- Clinical Pharmacy Department, College of Pharmacy, Prince Sattam bin Abdulaziz University, Al-Kharj 16273, Saudi Arabia; (S.A.A.); (O.S.A.); (A.Z.A.)
| | - Yasser S. Almogbel
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraidah 51452, Saudi Arabia;
| | - Rana E. Alonazi
- Pharmacology Department, College of Pharmacy, Prince Sattam bin Abdulaziz University, Al-Kharj 16273, Saudi Arabia;
| | - Waleed M. Alshehri
- Clinical Pharmacy Department, King Fahad Medical City, Riyadh 11525, Saudi Arabia;
| | - Hind A. Alkhelaifi
- Contracts Management Department, National Unified Procurement Company (NUPCO), Riyadh 12251, Saudi Arabia;
| | - Salman A. Almutairi
- Clinical Pharmacy Department, College of Pharmacy, Prince Sattam bin Abdulaziz University, Al-Kharj 16273, Saudi Arabia; (S.A.A.); (O.S.A.); (A.Z.A.)
| | - Omar S. Alenazi
- Clinical Pharmacy Department, College of Pharmacy, Prince Sattam bin Abdulaziz University, Al-Kharj 16273, Saudi Arabia; (S.A.A.); (O.S.A.); (A.Z.A.)
| | - Ali Z. Alali
- Clinical Pharmacy Department, College of Pharmacy, Prince Sattam bin Abdulaziz University, Al-Kharj 16273, Saudi Arabia; (S.A.A.); (O.S.A.); (A.Z.A.)
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Dooms M. Pharmacists are initiators in palliative care for patients with rare diseases. Orphanet J Rare Dis 2023; 18:141. [PMID: 37291601 DOI: 10.1186/s13023-023-02765-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 06/04/2023] [Indexed: 06/10/2023] Open
Abstract
The World Health Organization supports early delivery of palliative care as it reduces unnecessary hospital admissions and the inappropriate use of health care services. A community pharmacist can play a key role in advocating timely access to palliative care. Medication reconciliation must alert them to start communicating with the patient and/or his relatives about refocusing treatment and care as part of palliative and terminal care. Pharmaceutical activities for these patients include dispensing of devices and medicinal products, compounding personalized medication and participating as a member of the Palliative Support Team. Most of the several thousands of rare diseases are caused by genetic defects and up to now have no cure and a late diagnosis.
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Affiliation(s)
- M Dooms
- University Hospitals Leuven, Leuven, Belgium.
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Pharmacists' clinical roles and activities in inpatient hospice and palliative care: a scoping review. Int J Clin Pharm 2023:10.1007/s11096-023-01535-7. [PMID: 36773207 PMCID: PMC9918816 DOI: 10.1007/s11096-023-01535-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 01/03/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Pharmacists contribute to medication safety by providing their services in various settings. However, standardized definitions of the role of pharmacists in hospice and palliative care (HPC) are lacking. AIM The purpose of this scoping review was to provide an overview of the evidence on the role of pharmacists and to map clinical activities in inpatient HPC. METHOD We performed a scoping review according to the PRISMA-ScR extension in CINAHL, Embase, and PubMed. We used the American Society of Hospital Pharmacists (ASHP) Guidelines on the Pharmacist's Role in Palliative and Hospice Care as a framework for standardized categorization of the identified roles and clinical activities. RESULTS After screening 635 records (published after January 1st, 2000), the scoping review yielded 23 publications reporting various pharmacy services in HPC. The articles addressed the five main categories in the following descending order: 'Medication order review and reconciliation', 'Medication counseling, education and training', 'Administrative Roles', 'Direct patient care', and 'Education and scholarship'. A total of 172 entries were mapped to the subcategories that were added to the main categories. CONCLUSION This scoping review identified a variety of pharmacists' roles and clinical activities. The gathered evidence will help to establish and define the role of pharmacists in inpatient hospice and palliative care.
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Tanaka R, Satoh Y, Suga Y, Nakagawa J, Miyazaki M, Hagiwara R, Uchida M, Takase H. Japanese Nationwide Comparative Survey of Medication Guidance Provided by Certified and Uncertified Palliative Care Pharmacists. J NIPPON MED SCH 2023; 90:449-459. [PMID: 38246616 DOI: 10.1272/jnms.jnms.2023_90-613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
BACKGROUND As members of a medical team, pharmacists are expected to provide optimal patient-centered, evidence-based pharmacotherapy. In Japan, in consideration of the importance of palliative care, a system was initiated for certifying palliative care pharmacists in 2010. However, no studies have evaluated the usefulness of board certification in palliative pharmacy. Therefore, we surveyed the status of medication guidance for the physical and psychological symptoms of patients receiving palliative care and compared the medication guidance provided by certified and uncertified pharmacists. METHODS The survey was conducted in February and March 2022. Pharmacists registered as members of the Japanese Society of Pharmaceutical Palliative Care and Sciences were surveyed by using a web-based questionnaire and 209 pharmacists responded: the certified pharmacist group comprised 123 (58.9%) pharmacists and the uncertified pharmacist group comprised 86 (41.1%) pharmacists. RESULTS The certified pharmacist group provided better and more frequent medication guidance, according to responses to four of the six items related to pain relief. Three items were related to non-pain symptom relief, and one of the four items was related to psychiatric symptom relief (P < 0.05). The study showed that the certified pharmacist group received a better rating than the uncertified pharmacist group for involvement in palliative pharmacotherapy leading to improvement of patient quality of life (P < 0.05). CONCLUSION As compared with uncertified pharmacists, certified pharmacists intervened more proactively and provided a broader range of palliative care.
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Affiliation(s)
- Rei Tanaka
- Department of Pharmacy, Shizuoka Cancer Center
- Faculty of Pharmaceutical Sciences, Tokyo University of Science
| | | | - Yukio Suga
- Department of Clinical Pharmacy and Healthcare Science, Faculty of Pharmacy, Institute of Medical, Pharmaceutical & Health Science, Kanazawa University
| | - Junichi Nakagawa
- Department of Pharmacy, Daisan Hospital, The Jikei University School of Medicine
| | | | | | - Mayako Uchida
- Department of Education and Research Center for Pharmacy Practice, Faculty of Pharmaceutical Sciences, Doshisha Women's College of Liberal Arts
| | - Hisamitsu Takase
- Department of Pharmacy, Nippon Medical School Tama Nagayama Hospital
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Geiger J, Enck G, Luciani L, Fudin J, McPherson ML. Evolving Roles of Palliative Care Pharmacists. J Pain Symptom Manage 2022; 64:e357-e361. [PMID: 35940491 DOI: 10.1016/j.jpainsymman.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/15/2022] [Accepted: 07/21/2022] [Indexed: 01/04/2023]
Abstract
In this article, we provide an overview of pharmacists' involvement with palliative care, starting with recent history, up to present day. The aim of this review is to highlight advances in the field of palliative care pharmacy and the integral role pharmacists have on the palliative care team. We conclude that despite participating on multidisciplinary palliative care teams for over 20 years, pharmacy still lacks a board certification in palliative care.
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Affiliation(s)
| | - Gavin Enck
- OhioHealth (J.G., G.E.), Columbus, Ohio, USA
| | - Lisa Luciani
- Central Arkansas Veterans Health care System (L.L.), Little Rock, Arkansas, USA
| | - Jeffrey Fudin
- Albany College of Pharmacy (J.F.), Albany New York, USA
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Lockman K, Lowry MF, DiScala S, Lovell AG, Uritsky TJ, Kematick BS, Schmidt M, Wetshtein AM, Scullion B, Herndon CM, Atayee RS. Development of Entrustable Professional Activities for Specialist Hospice and Palliative Care Pharmacists. J Pain Symptom Manage 2022; 64:37-48. [PMID: 35304228 DOI: 10.1016/j.jpainsymman.2022.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/03/2022] [Accepted: 03/08/2022] [Indexed: 12/30/2022]
Abstract
CONTEXT Entrustable professional activities (EPAs) translate competencies into explicit, practical terms that clearly state the expected roles and responsibilities of clinicians who have achieved proficiency and expertise in a field. EPAs are defined for Hospice and Palliative Medicine physicians but not for other members of Hospice and Palliative Care (HAPC) interprofessional teams, including pharmacists. OBJECTIVES The objective of this study was to develop EPAs for HAPC pharmacists. METHODS An 11-member workgroup of HAPC pharmacists was convened to develop candidate EPAs using nominal group and modified-Delphi methods. Content validity index was used as a measure of consensus, defined a priori at ≥ 60%. Vetting occurred via intra- and interprofessional stakeholder reactor groups and a national survey of HAPC pharmacists. RESULTS Following an iterative process of workgroup and stakeholder consensus-building, 15 HAPC pharmacist EPAs were developed. Among the workgroup, all 15 EPAs reached ≥ 70% consensus, indicating appropriate internal validity. In a national survey of 185 HAPC pharmacists with a 20% response rate, 13 EPAs were rated by most respondents as "essential" and 2 were rated by most respondents as "important but not essential." Respondents indicated the 15 EPA set represented the core professional activities of HAPC pharmacists well (median rating of 5 on a Likert-like scale, IQR 1). CONCLUSION Fifteen consensus EPAs describe essential activities of HAPC pharmacists in direct patient care, leadership, education, and scholarship. These EPAs will further guide pharmacist training programs, HAPC services seeking to incorporate a specialized pharmacist on the team, and currently practicing HAPC pharmacists.
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Affiliation(s)
- Kashelle Lockman
- University of Iowa College of Pharmacy (K.L.), Iowa City, Iowa, USA; University of Pittsburgh School of Pharmacy (M.F.L.), Pittsburgh, Pennsylvania, USA; West Palm Beach (WPB) Veterans Affairs Medical Center (S.D.), West Palm Beach, Florida, USA; Optum Hospice Pharmacy Services (A.G.L.), Westerville, Ohio, USA; Department of Pharmacy (T.J.U.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Dana-Farber Cancer Institute (B.S.K.), Boston, Massachusetts, USA; University of Iowa College of Pharmacy (M.S.), Iowa City, Iowa, USA; Cleveland Clinic Fairview Hospital (A.M.W.), Cleveland, Ohio, USA; Dana-Farber Cancer Institute (B.S.), Boston, Massachusetts, USA; School of Pharmacy (C.M.H.), Southern Illinois University Edwardsville, Edwardsville, Illinois, USA; San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences (R.S.A.), University of California, San Diego, California, USA; San Diego Health, Palliative Care Program (R.S.A.), University of California, San Diego, California, USA.
| | - Maria F Lowry
- University of Iowa College of Pharmacy (K.L.), Iowa City, Iowa, USA; University of Pittsburgh School of Pharmacy (M.F.L.), Pittsburgh, Pennsylvania, USA; West Palm Beach (WPB) Veterans Affairs Medical Center (S.D.), West Palm Beach, Florida, USA; Optum Hospice Pharmacy Services (A.G.L.), Westerville, Ohio, USA; Department of Pharmacy (T.J.U.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Dana-Farber Cancer Institute (B.S.K.), Boston, Massachusetts, USA; University of Iowa College of Pharmacy (M.S.), Iowa City, Iowa, USA; Cleveland Clinic Fairview Hospital (A.M.W.), Cleveland, Ohio, USA; Dana-Farber Cancer Institute (B.S.), Boston, Massachusetts, USA; School of Pharmacy (C.M.H.), Southern Illinois University Edwardsville, Edwardsville, Illinois, USA; San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences (R.S.A.), University of California, San Diego, California, USA; San Diego Health, Palliative Care Program (R.S.A.), University of California, San Diego, California, USA
| | - Sandra DiScala
- University of Iowa College of Pharmacy (K.L.), Iowa City, Iowa, USA; University of Pittsburgh School of Pharmacy (M.F.L.), Pittsburgh, Pennsylvania, USA; West Palm Beach (WPB) Veterans Affairs Medical Center (S.D.), West Palm Beach, Florida, USA; Optum Hospice Pharmacy Services (A.G.L.), Westerville, Ohio, USA; Department of Pharmacy (T.J.U.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Dana-Farber Cancer Institute (B.S.K.), Boston, Massachusetts, USA; University of Iowa College of Pharmacy (M.S.), Iowa City, Iowa, USA; Cleveland Clinic Fairview Hospital (A.M.W.), Cleveland, Ohio, USA; Dana-Farber Cancer Institute (B.S.), Boston, Massachusetts, USA; School of Pharmacy (C.M.H.), Southern Illinois University Edwardsville, Edwardsville, Illinois, USA; San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences (R.S.A.), University of California, San Diego, California, USA; San Diego Health, Palliative Care Program (R.S.A.), University of California, San Diego, California, USA
| | - Amanda G Lovell
- University of Iowa College of Pharmacy (K.L.), Iowa City, Iowa, USA; University of Pittsburgh School of Pharmacy (M.F.L.), Pittsburgh, Pennsylvania, USA; West Palm Beach (WPB) Veterans Affairs Medical Center (S.D.), West Palm Beach, Florida, USA; Optum Hospice Pharmacy Services (A.G.L.), Westerville, Ohio, USA; Department of Pharmacy (T.J.U.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Dana-Farber Cancer Institute (B.S.K.), Boston, Massachusetts, USA; University of Iowa College of Pharmacy (M.S.), Iowa City, Iowa, USA; Cleveland Clinic Fairview Hospital (A.M.W.), Cleveland, Ohio, USA; Dana-Farber Cancer Institute (B.S.), Boston, Massachusetts, USA; School of Pharmacy (C.M.H.), Southern Illinois University Edwardsville, Edwardsville, Illinois, USA; San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences (R.S.A.), University of California, San Diego, California, USA; San Diego Health, Palliative Care Program (R.S.A.), University of California, San Diego, California, USA
| | - Tanya J Uritsky
- University of Iowa College of Pharmacy (K.L.), Iowa City, Iowa, USA; University of Pittsburgh School of Pharmacy (M.F.L.), Pittsburgh, Pennsylvania, USA; West Palm Beach (WPB) Veterans Affairs Medical Center (S.D.), West Palm Beach, Florida, USA; Optum Hospice Pharmacy Services (A.G.L.), Westerville, Ohio, USA; Department of Pharmacy (T.J.U.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Dana-Farber Cancer Institute (B.S.K.), Boston, Massachusetts, USA; University of Iowa College of Pharmacy (M.S.), Iowa City, Iowa, USA; Cleveland Clinic Fairview Hospital (A.M.W.), Cleveland, Ohio, USA; Dana-Farber Cancer Institute (B.S.), Boston, Massachusetts, USA; School of Pharmacy (C.M.H.), Southern Illinois University Edwardsville, Edwardsville, Illinois, USA; San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences (R.S.A.), University of California, San Diego, California, USA; San Diego Health, Palliative Care Program (R.S.A.), University of California, San Diego, California, USA
| | - Benjamin S Kematick
- University of Iowa College of Pharmacy (K.L.), Iowa City, Iowa, USA; University of Pittsburgh School of Pharmacy (M.F.L.), Pittsburgh, Pennsylvania, USA; West Palm Beach (WPB) Veterans Affairs Medical Center (S.D.), West Palm Beach, Florida, USA; Optum Hospice Pharmacy Services (A.G.L.), Westerville, Ohio, USA; Department of Pharmacy (T.J.U.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Dana-Farber Cancer Institute (B.S.K.), Boston, Massachusetts, USA; University of Iowa College of Pharmacy (M.S.), Iowa City, Iowa, USA; Cleveland Clinic Fairview Hospital (A.M.W.), Cleveland, Ohio, USA; Dana-Farber Cancer Institute (B.S.), Boston, Massachusetts, USA; School of Pharmacy (C.M.H.), Southern Illinois University Edwardsville, Edwardsville, Illinois, USA; San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences (R.S.A.), University of California, San Diego, California, USA; San Diego Health, Palliative Care Program (R.S.A.), University of California, San Diego, California, USA
| | - Michelle Schmidt
- University of Iowa College of Pharmacy (K.L.), Iowa City, Iowa, USA; University of Pittsburgh School of Pharmacy (M.F.L.), Pittsburgh, Pennsylvania, USA; West Palm Beach (WPB) Veterans Affairs Medical Center (S.D.), West Palm Beach, Florida, USA; Optum Hospice Pharmacy Services (A.G.L.), Westerville, Ohio, USA; Department of Pharmacy (T.J.U.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Dana-Farber Cancer Institute (B.S.K.), Boston, Massachusetts, USA; University of Iowa College of Pharmacy (M.S.), Iowa City, Iowa, USA; Cleveland Clinic Fairview Hospital (A.M.W.), Cleveland, Ohio, USA; Dana-Farber Cancer Institute (B.S.), Boston, Massachusetts, USA; School of Pharmacy (C.M.H.), Southern Illinois University Edwardsville, Edwardsville, Illinois, USA; San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences (R.S.A.), University of California, San Diego, California, USA; San Diego Health, Palliative Care Program (R.S.A.), University of California, San Diego, California, USA
| | - Andrea M Wetshtein
- University of Iowa College of Pharmacy (K.L.), Iowa City, Iowa, USA; University of Pittsburgh School of Pharmacy (M.F.L.), Pittsburgh, Pennsylvania, USA; West Palm Beach (WPB) Veterans Affairs Medical Center (S.D.), West Palm Beach, Florida, USA; Optum Hospice Pharmacy Services (A.G.L.), Westerville, Ohio, USA; Department of Pharmacy (T.J.U.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Dana-Farber Cancer Institute (B.S.K.), Boston, Massachusetts, USA; University of Iowa College of Pharmacy (M.S.), Iowa City, Iowa, USA; Cleveland Clinic Fairview Hospital (A.M.W.), Cleveland, Ohio, USA; Dana-Farber Cancer Institute (B.S.), Boston, Massachusetts, USA; School of Pharmacy (C.M.H.), Southern Illinois University Edwardsville, Edwardsville, Illinois, USA; San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences (R.S.A.), University of California, San Diego, California, USA; San Diego Health, Palliative Care Program (R.S.A.), University of California, San Diego, California, USA
| | - Bridget Scullion
- University of Iowa College of Pharmacy (K.L.), Iowa City, Iowa, USA; University of Pittsburgh School of Pharmacy (M.F.L.), Pittsburgh, Pennsylvania, USA; West Palm Beach (WPB) Veterans Affairs Medical Center (S.D.), West Palm Beach, Florida, USA; Optum Hospice Pharmacy Services (A.G.L.), Westerville, Ohio, USA; Department of Pharmacy (T.J.U.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Dana-Farber Cancer Institute (B.S.K.), Boston, Massachusetts, USA; University of Iowa College of Pharmacy (M.S.), Iowa City, Iowa, USA; Cleveland Clinic Fairview Hospital (A.M.W.), Cleveland, Ohio, USA; Dana-Farber Cancer Institute (B.S.), Boston, Massachusetts, USA; School of Pharmacy (C.M.H.), Southern Illinois University Edwardsville, Edwardsville, Illinois, USA; San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences (R.S.A.), University of California, San Diego, California, USA; San Diego Health, Palliative Care Program (R.S.A.), University of California, San Diego, California, USA
| | - Christopher M Herndon
- University of Iowa College of Pharmacy (K.L.), Iowa City, Iowa, USA; University of Pittsburgh School of Pharmacy (M.F.L.), Pittsburgh, Pennsylvania, USA; West Palm Beach (WPB) Veterans Affairs Medical Center (S.D.), West Palm Beach, Florida, USA; Optum Hospice Pharmacy Services (A.G.L.), Westerville, Ohio, USA; Department of Pharmacy (T.J.U.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Dana-Farber Cancer Institute (B.S.K.), Boston, Massachusetts, USA; University of Iowa College of Pharmacy (M.S.), Iowa City, Iowa, USA; Cleveland Clinic Fairview Hospital (A.M.W.), Cleveland, Ohio, USA; Dana-Farber Cancer Institute (B.S.), Boston, Massachusetts, USA; School of Pharmacy (C.M.H.), Southern Illinois University Edwardsville, Edwardsville, Illinois, USA; San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences (R.S.A.), University of California, San Diego, California, USA; San Diego Health, Palliative Care Program (R.S.A.), University of California, San Diego, California, USA
| | - Rabia S Atayee
- University of Iowa College of Pharmacy (K.L.), Iowa City, Iowa, USA; University of Pittsburgh School of Pharmacy (M.F.L.), Pittsburgh, Pennsylvania, USA; West Palm Beach (WPB) Veterans Affairs Medical Center (S.D.), West Palm Beach, Florida, USA; Optum Hospice Pharmacy Services (A.G.L.), Westerville, Ohio, USA; Department of Pharmacy (T.J.U.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Dana-Farber Cancer Institute (B.S.K.), Boston, Massachusetts, USA; University of Iowa College of Pharmacy (M.S.), Iowa City, Iowa, USA; Cleveland Clinic Fairview Hospital (A.M.W.), Cleveland, Ohio, USA; Dana-Farber Cancer Institute (B.S.), Boston, Massachusetts, USA; School of Pharmacy (C.M.H.), Southern Illinois University Edwardsville, Edwardsville, Illinois, USA; San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences (R.S.A.), University of California, San Diego, California, USA; San Diego Health, Palliative Care Program (R.S.A.), University of California, San Diego, California, USA
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9
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Moody JJ, Poon IO, Braun UK. The Role of an Inpatient Hospice and Palliative Clinical Pharmacist in the Interdisciplinary Team. Am J Hosp Palliat Care 2022; 39:856-864. [PMID: 34583554 PMCID: PMC8958171 DOI: 10.1177/10499091211049401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Palliative care is a specialized health care service for individuals with serious illness at any stage and can be provided in any setting. Current national consensus developed by palliative care experts recommends the inclusion of pharmacists in an interdisciplinary team (IDT) to provide quality palliative care. However, national registry data report that less than 10% of inpatient palliative teams in the U.S. have a clinical pharmacist. Clinical pharmacists have an impactful role in palliative patients' quality of life by optimizing symptom management, deprescribing, and providing education to the palliative care team as well as patients and their families. In this report, we review the current literature on the role of a palliative pharmacist in an inpatient palliative care setting and compare and contrast this with our own clinical practice, providing case examples about the role of a palliative clinical pharmacist in an interdisciplinary inpatient palliative care setting. Future strategies are needed to increase post-graduate specialized pharmacy residency training in palliative care as well as education on palliative and hospice care in pharmacy schools to support the role of clinical pharmacists in palliative care.
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Affiliation(s)
| | - Ivy O Poon
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Pharmacy Practice, Texas Southern University, College of Pharmacy and Health Sciences, Houston, TX, USA
| | - Ursula K Braun
- Section of Geriatrics and Palliative Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
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10
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Shrestha S, Kc B, Blebil AQ, Teoh SL. Pharmacist Involvement in Cancer Pain Management: A Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2022; 23:1123-1142. [PMID: 35151871 DOI: 10.1016/j.jpain.2022.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 12/10/2021] [Accepted: 02/05/2022] [Indexed: 06/14/2023]
Abstract
This review aimed to critically evaluate the impact of pharmacist involvement in managing pain in cancer patients. Databases (including MEDLINE, Embase and CENTRAL) were searched with a broad search strategy for studies involving pharmacists and cancer pain management until February 10, 2021. The quality of studies and evidence were assessed using standardized tools and GRADE, respectively. A random-effects model was used for meta-analysis. Sixty-four studies were included. Common interventions delivered by the pharmacists were medication review, patient education, adverse drug reactions (ADRs) detection and management, pharmacological recommendations (in dosing and pharmacotherapy choice), and pain assessment. A pooled analysis of 3 randomized control trials showed a significant reduction in pain intensity with a standardized mean difference (SMD) of 0.35 [95% confidence intervals (CI): -0.55, -0.16]. Pooled analyses from nonrandomized studies of interventions also showed significant results in reduction of ADRs with an odds ratio of 0.69 (95% CI: 0.61, 0.79) and improvement in quality of life with SMD of 0.80 (95% CI: 0.29, 1.32). Thus, pharmacists significantly improve the clinical outcomes of cancer patients related to pain. This indicates the involvement of pharmacists directly or in collaboration with healthcare professionals in the oncology team is highly beneficial for the patients. PERSPECTIVES: This systematic review presents a comprehensive evaluation of pharmacist involvement in cancer pain management. This shows the importance of direct involvement of the pharmacist or as an important member of the multidisciplinary oncology team.
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Affiliation(s)
- Sunil Shrestha
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia
| | - Bhuvan Kc
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia; College of Public Health, Medical & Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Ali Qais Blebil
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia; Department of Pharmacy, Al Rafidain University College, Baghdad, Iraq
| | - Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia.
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11
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Hill RR, Willett EC, Manuel JD, Delate T. Impact of Palliative Care Clinical Pharmacists in an Inpatient Care Setting on Total Health Care Expenditures. J Palliat Med 2022; 25:1518-1523. [PMID: 35442799 DOI: 10.1089/jpm.2021.0642] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Inpatient palliative care clinical pharmacy specialists (IPCPS) on multidisciplinary palliative care (PC) teams have expanding roles in the treatment of pain, nausea, and other symptoms for patients with serious illnesses. Objectives: The aim of this study was to assess the clinical and financial outcomes associated with an IPCPS on an inpatient PC team. Setting and Design: This was a retrospective cohort study conducted in Colorado. Adult patients with an inpatient stay and a PC consult between October 1, 2016 and February 28, 2019 were included. Patients were assigned to the observation group if they received PC from a clinical pharmacist and control group if they received usual PC. The primary outcome was the 180-day change in daily total cost-of-care expenditures. Secondary outcomes included length of index hospitalization and 180-day change in daily morphine milligram equivalents (MME), health care utilization, and opioid adverse effects (AE). Results: A total of 1543 patients were included with 228 and 1315 in the IPCPS and usual care groups, respectively. After adjustment, the IPCPS group had a greater median decrease in daily expenditures (-$22 vs. $6, p = 0.003), higher median increase in daily MME (16.5 vs. 9.7 mg, p = 0.007), and fewer patients with a subsequent hospitalization (34.2% vs. 39.2%, p = 0.010) or urgent care visit (10.5% vs. 14.6%, p = 0.024) but longer mean index hospitalization (9.3 vs. 7.7 days, p = 0.003) and no differences in AE during follow-up (all p > 0.05). Conclusion: IPCPS participation on the PC team can be a component of health care cost reduction while contributing to patient-centered quality care.
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Affiliation(s)
- Robin R Hill
- Department of Pharmacy, Kaiser Permanente Colorado, Aurora, Colorado, USA
| | | | - Jeffrey D Manuel
- Department of Supportive Care, Colorado Permanente Medical Group, Denver, Colorado, USA
| | - Thomas Delate
- Drug Evaluation, Strategy, and Outcomes Department, Kaiser Permanente National Pharmacy, Aurora, Colorado, USA.,Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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12
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Brennan F, Gardiner MD, Narasimhan M. The neuropalliative multidisciplinary team-Members and their roles. HANDBOOK OF CLINICAL NEUROLOGY 2022; 190:33-59. [PMID: 36055719 DOI: 10.1016/b978-0-323-85029-2.00010-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Neurodegenerative conditions are prominent contributors to both morbidity and mortality worldwide. They pose a significant challenge to health professionals, health systems, and the often unpaid, untrained family members and carers. The many and varied challenges encountered are best managed by a multidisciplinary neuropalliative team, as it is impossible for a single clinician to possess and deliver the wide range of skills and services required to optimally care for these patients. This chapter discusses the assembly, maintenance, and care of such a team, as well as potential difficulties and solutions in domains such as funding, training, geographical remoteness, as well as the potential lack of awareness and acceptance by colleagues. A comprehensive description of the role of all possible team members is discussed. The chapter outlines the concept, content, and potential benefits of a multidisciplinary team in neuropalliative care. Its thesis is twofold: that multidisciplinary care is vital and, second, that the sum of the whole of a team can be greater than the individual parts with respect to organization, planning, experience, and creativity of approach. With all these factors considered, and implemented wherever possible, we may all move closer to optimizing the comfort and care of our shared neuropalliative patients.
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Affiliation(s)
- Frank Brennan
- Departments of Palliative and Rehabilitation Medicine, Calvary and St George Hospitals, Sydney, NSW, Australia; The Faculty of Medicine, St George Clinical School, The University of New South Wales, Sydney, NSW, Australia.
| | - Matthew D Gardiner
- Departments of Palliative and Rehabilitation Medicine, Calvary and St George Hospitals, Sydney, NSW, Australia; The Faculty of Medicine, St George Clinical School, The University of New South Wales, Sydney, NSW, Australia
| | - Manisha Narasimhan
- School of Psychology and Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia; Department of Neurology, Sutherland Hospital, Sydney, NSW, Australia
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Hanley J, Spargo M, Brown J, Magee J. The Development of an Enhanced Palliative Care Pharmacy Service during the Initial COVID-19 Surge. PHARMACY 2021; 9:pharmacy9040196. [PMID: 34941628 PMCID: PMC8707779 DOI: 10.3390/pharmacy9040196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/05/2021] [Accepted: 12/07/2021] [Indexed: 11/16/2022] Open
Abstract
The Northern Health and Social Care Trust developed an enhanced palliative care pharmacy service for acute inpatients within a large hospital in Northern Ireland during the initial COVID-19 surge. By training additional staff, there was an opportunity to increase service provision, utilising palliative care pharmacy skills to undertake activities such as the symptom management of patients, appropriate management of medicines, improved access to medicines, advice for other healthcare professionals, and supporting discharge from the hospital. The data collected showed a mean of 6.8 interventions per patient, and that, irrespective of the demand resulting from the COVID-19 pandemic, the palliative care pharmacy team had a role in improving the quality of care for palliative and end-of-life patients. Subsequent data analysis also demonstrated associated cost saving and the potential for the palliative care pharmacy team to reduce the length of stay at the hospital.
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Affiliation(s)
- Jaquie Hanley
- Antrim Area Hospital, Northern Health and Social Care Trust, BT41 2RL Antrim, Ireland; (J.B.); (J.M.)
- Correspondence:
| | - Maureen Spargo
- Medicines Optimisation and Innovation Centre, Antrim Area Hospital, Northern Health and Social Care Trust, BT41 2RL Antrim, Ireland;
| | - Joanne Brown
- Antrim Area Hospital, Northern Health and Social Care Trust, BT41 2RL Antrim, Ireland; (J.B.); (J.M.)
| | - Julie Magee
- Antrim Area Hospital, Northern Health and Social Care Trust, BT41 2RL Antrim, Ireland; (J.B.); (J.M.)
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Salmany SS, Rayyan M, Dabbous A, Mughrabi AE. Descriptive study of clinical pharmacist interventions in adult hospice and palliative care at a comprehensive oncology center in Jordan. J Oncol Pharm Pract 2021; 28:1749-1753. [PMID: 34565251 DOI: 10.1177/10781552211040736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Few studies have evaluated the role of a clinical pharmacist in hospice and palliative care in oncology. We aimed to describe the intervention of a clinical pharmacist in hospice and palliative care at a comprehensive oncology center in Jordan. METHODS A retrospective descriptive study at a comprehensive oncology center in Jordan between 2006 and 2019. Quantifi® pharmacy documentation system was used to retrieve the clinical pharmacists' interventions in three hospice and palliative care settings, inpatient hospice and palliative care, outpatient hospice and palliative care clinics and home health care. Where clinical pharmacists document their interventions, significance and acceptance of the interventions by the physician is done using Quantifi®. RESULTS Over 13 years, 27,720 documented interventions were retrieved in the three settings of hospice and palliative care: inpatient hospice and palliative care, outpatient hospice and palliative care clinics and home health care setting. The most common reported interventions were drug therapy recommendation/discontinuation (41%), followed by medication reconciliation (21.7%) and patient counseling (16.8%). The medication classes most commonly associated with the hospice and palliative care clinical pharmacist interventions were analgesics (20.9%), antibiotics (19.7%), followed by medications for the nervous system (12.4%). The acceptance rate of the interventions by physicians was around (90%) and 100% of the interventions were considered significant. CONCLUSION Our study showed the high impact of the hospice and palliative care clinical pharmacist in oncology providing the high number of clinical pharmacists' interventions.
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Affiliation(s)
- Sewar S Salmany
- Department of Pharmacy, 37559King Hussein Cancer Center, Amman, Jordan
| | - Manal Rayyan
- Department of Pharmacy, 37559King Hussein Cancer Center, Amman, Jordan
| | - Ala'a Dabbous
- Department of Pharmacy, 37559King Hussein Cancer Center, Amman, Jordan
| | - Amani El Mughrabi
- Department of Pharmacy, 37559King Hussein Cancer Center, Amman, Jordan
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Yamada M, Uchida M, Hada M, Inma D, Ariyoshi S, Kamimura H, Haraguchi T. Evaluation of changes in pharmacist behaviors following a systematic education program on palliative care in cancer. CURRENTS IN PHARMACY TEACHING & LEARNING 2021; 13:417-422. [PMID: 33715805 DOI: 10.1016/j.cptl.2020.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/23/2020] [Accepted: 11/24/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND PURPOSE Attitudes, experience, and knowledge of healthcare professionals guide the care they provide and are particularly important factors affecting the quality of palliative care. Palliative care education for pharmacists is crucial for improving quality of care and effective participation on the palliative care team. EDUCATIONAL ACTIVITY AND SETTING We previously developed and reported a systematic and multifaceted pharmacist education program for cancer-related palliative care. We compared 12 behavioral changes immediately (August 2017) and two years after (October 2019) participation in this systematic education program (SEP) to evaluate if participants were performing pharmaceutical management appropriately and to assure that behaviors had not deteriorated. FINDINGS Of 88 participants in the SEP, 36 responded to the survey (response rate 40.9%). There was no significant difference in the behavioral change items of pharmacists immediately after participating in the SEP (2017) and two years later (2019) (4.47 vs. 4.58, P = .47). SUMMARY We confirmed that behavioral changes developed by the SEP were maintained over a significant time. This indicates that knowledge was firmly established in the participants such that they could continue utilizing it long after participating in the SEP. Our study showed that participating in this SEP not only enabled participants to acquire knowledge regarding palliative medicine but also led to continued behavioral changes based on this knowledge.
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Affiliation(s)
- Masahiro Yamada
- Department of Pharmacy, Kitakyushu Municipal Medical Center, 2-1-1, Bashaku, Kokurakita-ku, Kitakyushu, Fukuoka 802-0077, Japan.
| | - Mayako Uchida
- Pharmaceutical Sciences Education and Research Center for Clinical Pharmacy, Osaka University of Pharmaceutical Sciences, 4-20-1 Nasahara, Takatsuki, Osaka 569-1094, Japan.
| | - Masao Hada
- Department of Pharmacy, Japan Community Health care Organization Nankai Medical Center, 7-8, Tokiwanishimachi, Saiki, Oita 876-0857, Japan.
| | - Daigo Inma
- A public interest incorporated foundation, Fukuoka Pharmaceutical Association, 2-20-15, Sumiyoshi, Hakata-ku, Fukuoka 812-0018, Japan.
| | - Shunji Ariyoshi
- A public interest incorporated foundation, Fukuoka Pharmaceutical Association, 2-20-15, Sumiyoshi, Hakata-ku, Fukuoka 812-0018, Japan.
| | - Hidetoshi Kamimura
- Department of Pharmacy, Fukuoka University Hospital, 7-45-1, Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
| | - Tohru Haraguchi
- A public interest incorporated foundation, Fukuoka Pharmaceutical Association, 2-20-15, Sumiyoshi, Hakata-ku, Fukuoka 812-0018, Japan.
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Malotte K, Naidu DR, Herndon CM, Atayee RS. Multicentered Evaluation of Palliative Care Pharmacists' Interventions and Outcomes in California. J Palliat Med 2021; 24:1358-1363. [PMID: 33625895 DOI: 10.1089/jpm.2020.0566] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: The palliative care (PC) pharmacist's role within PC teams is increasingly recognized with favorable outcomes being reported. Methods: Retrospective study evaluated hospitalized adults seen by PC pharmacists, as part of PC consultation team at three California institutions. The primary objective was to categorize pharmacists' interventions. Secondary end points included length from admission to PC pharmacist involvement and symptom improvement following pharmacist intervention. Results: Data were collected for a total of 557 patients. Over the study period, the PC pharmacists provided 1466 medication recommendations and 2545 nonsymptom-based interventions. Average length of stay (LOS) was 15.6 days with mean time to PC service referral of 3.6 days. PC pharmacist consult occurred after a mean of 4.3 days after PC team consulted. LOS was significantly lower if seen by PC pharmacist within 72 hours of PC consultation, 12.3 days versus 24.5 days (p < 0.001), as well as when serving as lead clinician 9.3 days versus 15.5 days (p < 0.001). Achievement of severity goal was significantly higher at 24 and 72 hours assessment periods when received a medication recommendation for pain, dyspnea, anxiety, and constipation. Conclusion: PC pharmacists provide substantial transdisciplinary interventions. Significantly decreased LOS was found when PC pharmacist was involved within 72 hours of initial PC consultation and when served as lead clinician. Improved symptom goal attainment was demonstrated for pain, dyspnea, anxiety, and constipation. In summary, integration of a PC pharmacist on a PC team can be relied upon to provide patient-centered, transdisciplinary care and enhance symptom management.
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Affiliation(s)
- Kasey Malotte
- Supportive Care Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Dharma R Naidu
- Department of Pharmacy, Community Hospital of the Monterey Peninsula, Monterey, California, USA
| | - Christopher M Herndon
- School of Pharmacy, Southern Illinois University Edwardsville, Edwardsville, Illinois, USA
| | - Rabia S Atayee
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, California, USA.,San Diego Health Palliative Care Team, University of California, San Diego, La Jolla, California, USA
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Ding H, Zheng X, Kong S, Gong L, Ding Q, Huang P. Multidisciplinary intervention incorporating pharmacists in management of opioid-naïve patients with moderate to severe cancer pain. Eur J Cancer Care (Engl) 2020; 29:e13225. [PMID: 31971652 DOI: 10.1111/ecc.13225] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 11/01/2019] [Accepted: 11/21/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study aims to investigate the impact of intervention of multidisciplinary team incorporating pharmacists for management of opioid-naïve patients with moderate to severe cancer pain. METHODS A retrospective cohort study was conducted to compare pre- and post-multidisciplinary intervention groups in opioid-naïve patients with moderate to severe cancer pain. Primary outcome was the proportions of appropriate pain assessment and opioid titration. Secondary outcomes were pain intensity (PI), length of hospital stay, opioid escalation index percentage (OEI%) and incidences of opioid-related adverse events. RESULTS A total of 400 patients were included in the study (pre-intervention, n = 200; post-intervention, n = 200). Continuous improvement in pain assessment and titration was recorded after intervention. Though no substantial differences existed between groups in PI on the day of discharge, post-intervention group was associated with reduced length of hospital stay as well as decreased proportion of subjects with OEI% >5%. As for safety, significant decreases in constipation and vomiting were seen. CONCLUSION Findings suggest that interventions of multidisciplinary team incorporating pharmacists could improve cancer pain management for opioid-naïve patients. Pharmacists should be considered as an important member of a multidisciplinary team in good pain management.
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Affiliation(s)
- Haiying Ding
- Department of Pharmacy, Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
| | - Xiaowei Zheng
- Department of Pharmacy, Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
| | - Sisi Kong
- Department of Pharmacy, Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
| | - Liyan Gong
- Department of Medical Oncology, Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
| | - Qunfang Ding
- Department of Medical Oncology, Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
| | - Ping Huang
- Department of Pharmacy, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
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Edmonds KP, Saunders IM, Willeford A, Ajayi TA, Atayee RS. Emerging Challenges to the Safe and Effective Use of Methadone for Cancer-Related Pain in Paediatric and Adult Patient Populations. Drugs 2019; 80:115-130. [PMID: 31820362 DOI: 10.1007/s40265-019-01234-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Methadone continues to be an important medication for the treatment of paediatric and adult cancer-related pain. Appropriate patient selection to ensure safe and effective treatment by a team of clinicians who appreciate and are familiar with methadone and its unique pharmacology is crucial. Unlike morphine and other more common opioids, methadone is purported to have involvement with delta-opioid receptor and higher affinity as an N-methyl-D-aspartate-receptor antagonist. Clinically this gives it the advantage of being effective for both nociceptive and neuropathic pain, but also may be useful in the setting of tolerance to other opioids. Methadone also comes in multiple available formulations that can be administrated through a variety of routes beyond the oral route. Challenges with methadone in treating cancer-related pain include drug interactions specifically as it relates to new targeted cancer therapies. Recent guidelines recommend electrocardiogram monitoring with methadone and there is potential for additive cardiac toxicity in the oncology setting. Appropriate dosing of methadone for pain management given age, organ dysfunction, and patients who are on methadone maintenance therapy are also key factors. This article aims to provide clinicians with evidence and clinical practice guidelines for safe and appropriate use of methadone including indication, initiation, and monitoring given its complexity for management of pain in the dynamic oncology setting.
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Affiliation(s)
- Kyle P Edmonds
- Doris A. Howell Palliative Care Teams, University of California San Diego, La Jolla, CA, 92093, USA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, 92093, USA
| | - Ila M Saunders
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, 92093, USA
- Department of Pharmacy, University of California San Diego Health, La Jolla, CA, USA
| | - Andrew Willeford
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, 92093, USA
- Department of Pharmacy, University of California San Diego Health, La Jolla, CA, USA
| | - Toluwalase A Ajayi
- Digital Medicine, Scripps Research Translational Institute, La Jolla, CA, 92037, USA
| | - Rabia S Atayee
- Doris A. Howell Palliative Care Teams, University of California San Diego, La Jolla, CA, 92093, USA.
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, 92093, USA.
- Department of Pharmacy, University of California San Diego Health, La Jolla, CA, USA.
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Awdishu L, Singh RF, Saunders I, Yam FK, Hirsch JD, Lorentz S, Atayee RS, Ma JD, Tsunoda SM, Namba J, Mnatzaganian CL, Painter NA, Watanabe JH, Lee KC, Daniels CD, Morello CM. Advancing Pharmacist Collaborative Care within Academic Health Systems. PHARMACY 2019; 7:pharmacy7040142. [PMID: 31614555 PMCID: PMC6958419 DOI: 10.3390/pharmacy7040142] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 09/10/2019] [Accepted: 10/05/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction: The scope of pharmacy practice has evolved over the last few decades to focus on the optimization of medication therapy. Despite this positive impact, the lack of reimbursement remains a significant barrier to the implementation of innovative pharmacist practice models. Summary: We describe the successful development, implementation and outcomes of three types of pharmacist collaborative care models: (1) a pharmacist with physician oversight, (2) pharmacist–interprofessional teams and (3) physician–pharmacist teams. The outcome measurement of these pharmacist care models varied from the design phase to patient volume measurement and to comprehensive quality dashboards. All of these practice models have been successfully funded by affiliated health systems or grants. Conclusions: The expansion of pharmacist services delivered by clinical faculty has several benefits to affiliated health systems: (1) significant improvements in patient care quality, (2) access to experts in specialty areas, and (3) the dissemination of outcomes with national and international recognition, increasing the visibility of the health system.
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Affiliation(s)
- Linda Awdishu
- San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, CA 92093, USA.
- San Diego Health System, University of California, La Jolla, CA 92093, USA.
| | - Renu F Singh
- San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, CA 92093, USA.
- San Diego Health System, University of California, La Jolla, CA 92093, USA.
| | - Ila Saunders
- San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, CA 92093, USA.
- San Diego Health System, University of California, La Jolla, CA 92093, USA.
| | - Felix K Yam
- San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, CA 92093, USA.
- Veterans Affairs San Diego Healthcare System, La Jolla, CA 92093, USA.
| | - Jan D Hirsch
- San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, CA 92093, USA.
- Irvine School of Pharmacy and Pharmaceutical Sciences, University of California, Irvine, CA 92697, USA.
| | - Sarah Lorentz
- San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, CA 92093, USA.
| | - Rabia S Atayee
- San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, CA 92093, USA.
- San Diego Health System, University of California, La Jolla, CA 92093, USA.
| | - Joseph D Ma
- San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, CA 92093, USA.
- San Diego Health System, University of California, La Jolla, CA 92093, USA.
| | - Shirley M Tsunoda
- San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, CA 92093, USA.
- San Diego Health System, University of California, La Jolla, CA 92093, USA.
| | - Jennifer Namba
- San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, CA 92093, USA.
- San Diego Health System, University of California, La Jolla, CA 92093, USA.
| | - Christina L Mnatzaganian
- San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, CA 92093, USA.
- San Diego Health System, University of California, La Jolla, CA 92093, USA.
| | - Nathan A Painter
- San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, CA 92093, USA.
- San Diego Health System, University of California, La Jolla, CA 92093, USA.
| | - Jonathan H Watanabe
- San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, CA 92093, USA.
| | - Kelly C Lee
- San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, CA 92093, USA.
- San Diego Health System, University of California, La Jolla, CA 92093, USA.
| | - Charles D Daniels
- San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, CA 92093, USA.
- San Diego Health System, University of California, La Jolla, CA 92093, USA.
| | - Candis M Morello
- San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, CA 92093, USA.
- Veterans Affairs San Diego Healthcare System, La Jolla, CA 92093, USA.
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Crul M, Oosterhof P. The oncology pharmacist as part of the palliative treatment team. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2019; 28:92-96. [PMID: 31576620 PMCID: PMC7004026 DOI: 10.1111/ijpp.12583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 08/26/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Patients who are no longer eligible for curative treatment often suffer from multiple complaints and require a multidisciplinary treatment approach. We incorporated two pharmacists in the palliative team, one hospital pharmacist and one pharmacist who were trained as a community pharmacist. The objective of our study was to evaluate their contribution to the palliative team. METHODS During 13 months, the two pharmacists participated in all regular patient reviews and rounds and were available for individual consultation by all members of the palliative team on a daily basis. Each intervention (consults at request or during the patient rounds) was logged and categorised. KEY FINDINGS During the study period, 115 patients were under the care of the palliative treatment team. The pharmacists were actively involved in 107 of these (93%). Pharmacists interventions occurred in 76% of patients, with an average of 1.5 interventions per patient. The most common intervention types were giving general therapeutic advice, starting of a drug for an uncontrolled symptom and stopping a drug that was given as prophylaxis. When comparing the contribution of the hospital pharmacist and the outpatient pharmacist, their interventions overlapped with regard to starting drugs, choice of drugs and side-effect management. However, interventions on parenteral drugs or optimising the route of administration mostly came from the hospital pharmacist, whereas the outpatient pharmacist more often intervened in increasing adherence and stopping drugs. CONCLUSION The palliative pharmacist team adds expertise to the palliative treatment team, with an active contribution in 76% of patients.
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Affiliation(s)
- Mirjam Crul
- Department of Clinical Pharmacology and Pharmacy, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Piter Oosterhof
- Department of Clinical Pharmacy, OLVG, Amsterdam, The Netherlands.,Department of Pharmacy, Radboud University Medical Center, Nijmegen, The Netherlands
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Abstract
BACKGROUND The effect of integrating clinical pharmacists in German palliative care units with regard to the quality of drug therapy and drug costs has yet not been evaluated. OBJECTIVES This work aims to assess the number of pharmaceutical interventions (PI) and the cost-benefit ratio of a clinical pharmacist taking part in the interprofessional patient care team on an inpatient palliative care unit in Germany. METHODS The number of and underlying reasons for the pharmacist-led recommendations were recorded and analyzed over a 1-year period. In addition, the respective drugs and the acceptance rate of recommendations were assessed. To evaluate the cost-benefit ratio, the financial savings in the provision of drugs were recorded and compared with the expenses for the clinical pharmacy service. RESULTS A total of 245 PI were performed. Most frequently, the pharmacist advised physicians on drug choices and drug dosages. The acceptance rate was 93%. The cost savings in the provision of drugs covered 83% of the expenses for the clinical pharmacy service. CONCLUSION The results indicate that the integration of a clinical pharmacist is well suited to optimizing the interprofessional treatment of distressing symptoms with a beneficial economic outcome in palliative care. Consequently, the permanent integration of a clinical pharmacist on an inpatient palliative care unit seems to be beneficial and advisable.
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Basri DS, DiScala SL, Brooks AT, Vartan CM, Silverman MA, Quellhorst J. Analysis of Inpatient Hospice Pharmacist Interventions Within a Veterans Affairs Medical Center. J Pain Palliat Care Pharmacother 2019; 32:240-247. [PMID: 31290723 DOI: 10.1080/15360288.2019.1615025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Clinical pharmacy interventions have been shown to improve medication therapy, prevent undesirable side effects, and improve patients' clinical outcomes in a number of settings; however, limited data exist to characterize clinical pharmacy specialist (CPS) providers' interventions in an inpatient hospice Veteran Affairs (VA) setting. The primary objective of this quality improvement (QI) project was to quantify the number and types of pharmacy interventions implemented from the Pharmacists Achieve Results with Medications Documentation (PhARMD) tool for inpatient hospice patient encounters in a VA medical center. A total of 453 interventions during 185 patient care encounters were documented by CPS providers between September 1, 2016, and December 31, 2016. These interventions were documented across 32 unique patients, with an average of 14.2 interventions made per patient during this period. CPS providers frequently intervened to optimize pharmacotherapy for the treatment of pain (42.38%), terminal agitation (5.08%), and nausea (3.97%). Additionally, CPS providers played a significant role in the deprescribing of medication by discontinuing drugs no longer indicated (18.3%). These results substantiate the valuable contribution to patient care that the CPS providers make in optimizing symptom management and deprescribing at end-of-life. Future studies are needed to characterize the potential cost savings of CPS provider services in the inpatient hospice setting.
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Pruskowski J, Patel R, Brazeau G. The Need for Palliative Care in Pharmacy Education. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2019; 83:7410. [PMID: 31333268 PMCID: PMC6630864 DOI: 10.5688/ajpe7410] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 02/28/2019] [Indexed: 06/10/2023]
Abstract
There is a growing need for palliative care pharmacists in the United States. There is also a gap in the education of palliative care for pharmacy students. To address both, pharmacy schools must develop and disseminate palliative care-focused experiences, including traditional didactic lectures, problem-based learning, interactive skills, laboratory- and web-based experiences. This commentary presents the need for palliative care-focused experiences in the Doctor of Pharmacy (PharmD) degree program, and how schools can take smaller steps to tackle this issue.
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Affiliation(s)
| | - Ravi Patel
- University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
| | - Gayle Brazeau
- Marshall University, Huntington, West Virginia
- Editor, American Journal of Pharmaceutical Education, Arlington, Virginia
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Geum MJ, Ahn JH, Kim JS, Kim SH, Son ES, Hu YJ, Choi HJ, Rhie SJ. Interprofessional Collaboration Between a Multidisciplinary Palliative Care Team and the Team Pharmacist on Pain Management. Am J Hosp Palliat Care 2019; 36:616-622. [DOI: 10.1177/1049909119829047] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Min Jung Geum
- Department of Pharmacy, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
- Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea
| | - Ji Hyune Ahn
- Department of Pharmacy, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Jae Song Kim
- Department of Pharmacy, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Soo Hyun Kim
- Department of Pharmacy, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Eun Sun Son
- Department of Pharmacy, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Youn Jung Hu
- Palliative Care Center, Yonsei Cancer Center, Seoul, Republic of Korea
| | - Hye Jin Choi
- Palliative Care Center, Yonsei Cancer Center, Seoul, Republic of Korea
- Division of Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sandy Jeong Rhie
- Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea
- College of Pharmacy, Ewha Womans University, Seoul, Republic of Korea
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