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Mujtaba SH, Gazerani P. Exploring the Role of Community Pharmacists in Pain Management: Enablers and Challenges. PHARMACY 2024; 12:111. [PMID: 39051395 PMCID: PMC11270416 DOI: 10.3390/pharmacy12040111] [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: 06/24/2024] [Revised: 07/07/2024] [Accepted: 07/16/2024] [Indexed: 07/27/2024] Open
Abstract
Pain is a common complaint, and the consumption of analgesics is prevalent. Community pharmacists, as primary contact points for patients, can play a crucial role in guiding patients toward rational pharmacotherapy or alternative pain management strategies. However, there are no specific educational curricula or standard guidelines to support this role, and the perception of this potential role is not well known. We conducted an anonymous online questionnaire among community pharmacists in Norway to assess their knowledge, perspectives, and willingness to engage in pain care. The survey also explored potential facilitators and barriers, and the use of any current guidelines. Seventy-one community pharmacists participated from various regions in Norway. Findings revealed that community pharmacists felt knowledgeable and willing to engage in pain management but anticipated barriers such as time constraints and a lack of standard guidelines. Participants also highlighted the need for better collaboration with other healthcare professionals and continuous professional development to enhance their role. To optimize the role of community pharmacists in pain management, therefore, integrating them into multidisciplinary healthcare teams, minimizing barriers, and providing continuous education and standard guidelines seem essential. This approach can empower community pharmacists and improve pain management outcomes.
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Affiliation(s)
- Syed Hassan Mujtaba
- Department of Life Sciences and Health, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway
| | - Parisa Gazerani
- Department of Life Sciences and Health, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9260 Gistrup, Denmark
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Shrestha S, Iqbal A, Teoh SL, Khanal S, Gan SH, Lee SWH, Paudyal V. Impact of pharmacist-delivered interventions on pain-related outcomes: An umbrella review of systematic reviews and meta-analyses. Res Social Adm Pharm 2024; 20:34-51. [PMID: 38514293 DOI: 10.1016/j.sapharm.2024.03.005] [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] [Received: 11/10/2023] [Revised: 03/09/2024] [Accepted: 03/12/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION Pain is a significant healthcare challenge, impacting millions worldwide. Pharmacists have increasingly taken on expanded roles in managing pain, particularly in primary and ambulatory care contexts. This umbrella review aims to systematically evaluate evidence from published systematic reviews that explore the impact of pharmacist-delivered interventions on clinical, humanistic, and economic outcomes related to pain. METHODS A systematic search was conducted across six electronic databases, including Ovid Embase, MEDLINE, CINAHL, Scopus, CENTRAL, APA PsycINFO, and DARE, from inception until June 2023. Prior to inclusion, two independent reviewers assessed study titles and abstracts. Following inclusion, an assessment of the methodological quality of the included studies was conducted. AMSTAR 2 was used to evaluate the methodological quality of the included SRs. RESULTS From 2055 retrieved titles, 11 systematic reviews were included, with 5 out of 11 being meta-analyses. These SRs encompassed diverse pharmacist-led interventions such as education, medication reviews, and multi-component strategies targeting various facets of pain management. These findings showed favorable clinical outcomes, including reduced pain intensity, improved medication management, enhanced overall physical and mental well-being, and reduced hospitalization durations. Significant pain intensity reductions were found due to pharmacists' interventions, with standardized mean differences (SMDs) ranging from -0.76 to -0.22 across different studies and subgroups. Physical functioning improvements were observed, with SMDs ranging from -0.38 to 1.03. Positive humanistic outcomes were also reported, such as increased healthcare provider confidence, patient satisfaction, and quality of life (QoL). QoL improvements were reported, with SMDs ranging from 0.29 to 1.03. Three systematic reviews examined pharmacist interventions' impact on pain-related economic outcomes, highlighting varying cost implications and the need for robust research methodologies to capture costs and benefits. CONCLUSION This umbrella review highlights the effectiveness of pharmacist-delivered interventions in improving clinical, humanistic, and economic outcomes related to pain management. Existing evidence emphasises on the need to integrate pharamacists into multi-disciplinary pain management teams. Further research is needed to investigate innovative care models, such as pharmacist-independent prescribing initiatives within collaborative pain management clinics.
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Affiliation(s)
- Sunil Shrestha
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia.
| | - Ayesha Iqbal
- Office of Lifelong Learning and the Physician Learning Program, Faculty of Medicine and Dentistry, University of Alberta, AB, T6G1C9, Edmonton, Canada.
| | - Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia.
| | - Saval Khanal
- Health Economics Consulting, Norwich Medical School, University of East Anglia, Bob Champion Research & Education Building, UEA Research Park Rosalind Franklin Rd, NR4 7UQ, Norwich, United Kingdom.
| | - Siew Hua Gan
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia.
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia; School of Pharmacy, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, Malaysia; Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well Being Cluster, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia; Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia.
| | - Vibhu Paudyal
- School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham Edgbaston, Birmingham, United Kingdom; Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom.
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Janbakhsh M, Ratliff P, Ross J, Cottingham L, Tobin M, Busch H. Evaluating Outcomes of a Pharmacist-Driven Pain Management Consult Service. J Pain Palliat Care Pharmacother 2022; 36:145-151. [PMID: 35675066 DOI: 10.1080/15360288.2022.2084208] [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: 10/18/2022]
Abstract
The opioid crisis continues to place a significant burden on American families and the healthcare system. To date, there is an evolving body of evidence demonstrating that pharmacists can positively impact patient care in the pain management specialty. The purpose of this study is to evaluate 24-hour average pain scores before and after a clinical pharmacist completes a physician-ordered pain consult in a community hospital setting. For the primary outcome, there was a statistically significant reduction in pain scores 48 hours post consult (6.5 vs. 5.2; p < 0.001; Table 3) and 24 hours prior to discharge (6.1 vs. 4.5; p < 0.001; Table 3) when compared to pain scores 24 hours prior to consult. Additionally, there was a statistically significant reduction in the number of morphine milligram equivalents (MMEs) at 48 hours post consult (149.4 vs. 133.8; p < 0.001; Table 4) and 24 hours prior to discharge (136.5 vs. 100.6; p < 0.001; Table 4) when compared to 24 hours prior to consult. This pharmacist-driven pain consult service demonstrated a statistically significant reduction in pain scores while simultaneously reducing MME utilization and the number of opioids ordered, using a multimodal evidence-driven approach to pain management in a community hospital.
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Affiliation(s)
- Michael Janbakhsh
- Department of Pharmacy, Saint Joseph Hospital, Lexington, Kentucky, USA
| | - Patrick Ratliff
- Department of Pharmacy, Saint Joseph Hospital, Lexington, Kentucky, USA
| | - James Ross
- Department of Pharmacy, Saint Joseph Hospital, Lexington, Kentucky, USA
| | - Lauren Cottingham
- Department of Pharmacy, Saint Joseph Hospital, Lexington, Kentucky, USA
| | - Morgan Tobin
- Department of Pharmacy, Saint Joseph Hospital, Lexington, Kentucky, USA
| | - Haley Busch
- Department of Pharmacy, Saint Joseph Hospital, Lexington, Kentucky, USA
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Muzzio K, Chandler M, Painter JT, Dragic L. Characterizing Patients after Opioid Taper in a VA Medical Center. J Pain Palliat Care Pharmacother 2021; 35:84-90. [PMID: 33956566 DOI: 10.1080/15360288.2021.1900492] [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: 10/21/2022]
Abstract
To identify potential areas for intervention and gain insight on current practice in patients who are tapered to zero morphine equivalent daily doses (MEDD) through the Pharmacy Pain E-Consult at a Veterans Healthcare System. This was done by describing the types of follow-up care and resources utilized by patients. This project is a retrospective chart review of Veterans with non-cancer pain on chronic-opioid therapy consulted to the pharmacy e-consult service and tapered to 0 MEDD. Descriptive statistics are collected one year pre-taper and one year post-taper. One year post-taper, approximately one-third of the patients were re-started on opioid therapy. However, average MEDD overall was significantly decreased one year post-taper compared to pre-taper. Average pain scores were not significantly different pre-taper compared to post-taper. Non-opioid medications generally increased post-taper. Follow-up with mental health and pain management clinical pharmacy specialists decreased post-taper. Tapering to zero MEDD did not lead to a significant increase in pain one-year post-taper; however, approximately 33% of patients were re-started on opioids within one year post-taper. Average MEDD scores decreased post-taper as expected but with effects on mental health being largely unknown, we believe that further study in this area will help us better support patients.
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Affiliation(s)
- Kathryn Muzzio
- Kathryn Muzzio, PharmD, BCPS, Michael Chandler, PharmD, BCGP, and Lisa Dragic, PharmD, BCPS, are with the Pharmacy, Central Arkansas Veterans Healthcare System, John L. McClellan Memorial Veterans Hospital, Little Rock, Arkansas, USA; Jacob T. Painter, PharmD, MBA, PhD, is with the Core Investigator, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR Director and Associate Professor, Division of Pharmaceutical Evaluation & Policy, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Michael Chandler
- Kathryn Muzzio, PharmD, BCPS, Michael Chandler, PharmD, BCGP, and Lisa Dragic, PharmD, BCPS, are with the Pharmacy, Central Arkansas Veterans Healthcare System, John L. McClellan Memorial Veterans Hospital, Little Rock, Arkansas, USA; Jacob T. Painter, PharmD, MBA, PhD, is with the Core Investigator, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR Director and Associate Professor, Division of Pharmaceutical Evaluation & Policy, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jacob T Painter
- Kathryn Muzzio, PharmD, BCPS, Michael Chandler, PharmD, BCGP, and Lisa Dragic, PharmD, BCPS, are with the Pharmacy, Central Arkansas Veterans Healthcare System, John L. McClellan Memorial Veterans Hospital, Little Rock, Arkansas, USA; Jacob T. Painter, PharmD, MBA, PhD, is with the Core Investigator, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR Director and Associate Professor, Division of Pharmaceutical Evaluation & Policy, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Lisa Dragic
- Kathryn Muzzio, PharmD, BCPS, Michael Chandler, PharmD, BCGP, and Lisa Dragic, PharmD, BCPS, are with the Pharmacy, Central Arkansas Veterans Healthcare System, John L. McClellan Memorial Veterans Hospital, Little Rock, Arkansas, USA; Jacob T. Painter, PharmD, MBA, PhD, is with the Core Investigator, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR Director and Associate Professor, Division of Pharmaceutical Evaluation & Policy, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Thapa P, Lee SWH, Kc B, Dujaili JA, Mohamed Ibrahim MI, Gyawali S. Pharmacist-led intervention on chronic pain management: A systematic review and meta-analysis. Br J Clin Pharmacol 2021; 87:3028-3042. [PMID: 33486825 DOI: 10.1111/bcp.14745] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 01/05/2021] [Accepted: 01/17/2021] [Indexed: 12/25/2022] Open
Abstract
AIMS Pharmacists have been contributing to the management of chronic pain, ensuring the quality use of medicine. However, there is diversity in the interventions provided by pharmacists and their impact. METHODS Six electronic databases were searched from inception until June 2020 for articles published in English examining the intervention provided by the pharmacist in chronic pain management. Studies investigating the impact of pharmacist intervention individually or multidisciplinary teams including pharmacists for chronic pain management were included. RESULTS Fourteen studies (2365 participants) were included in the current review. Six studies were randomized controlled trials while the remainder were observational studies in which pharmacists provided intervention individually or in collaboration with other healthcare professionals. Medication review was the most common intervention provided by the pharmacist. The pooled analysis found that pharmacist-led interventions reduced the pain intensity (-0.22; 95% confidence interval [CI]: -0.35 to -0.09; moderate certainty) among participants with chronic pain. Opiate stewardship provided by pharmacists was effective; however, mixed results were noted on the impact of the intervention on physical functioning, anxiety, depression and quality of life. Pharmacist intervention was more expensive than treatment as usual. CONCLUSIONS Pharmacists contribute substantially to chronic pain management, ensuring the quality use of medicine, resulting in reduced pain intensity. Further studies with rigorous design are needed to measure the impact of pharmacist-provided intervention individually or in a multidisciplinary team on the economic benefit and other health outcomes.
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Affiliation(s)
- Parbati Thapa
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia
| | - Shaun Wen Huey Lee
- 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, QLD, Australia
| | | | | | - Sudesh Gyawali
- Department of Pharmacology, Manipal College of Medical Sciences, Pokhara, Nepal
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Gadd S, Cox N, Samuelson J, Kenney A, Turner K, Cochran G. Abuse-Deterrent Opioid Formulations and the Opioid Crisis: A Pharmacist's Perspective. Ther Drug Monit 2021; 43:35-41. [PMID: 33278243 DOI: 10.1097/ftd.0000000000000844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/04/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND For over 20 years, the United States has suffered the detrimental effects of an opioid epidemic. Extended-release opioid products are particularly prone to abuse due to the high amount of opioid present. By bypassing the controlled-release mechanisms and nonoral administration, individuals experience intense and dangerous "highs." Abuse-deterrent opioid formulations have been recommended as a potential solution to the crisis, but widespread utilization has been stunted and their role in therapy remains unclear owing to limited real-world efficacy data and affordability issues. This review discusses abuse-deterrent opioid formulations, the mechanisms and data underlying available products, and a pharmacist's perspective of their role in the opioid crisis. METHODS The authors reviewed PubMed, MEDLINE, and Google Scholar electronic databases for premarketing and postmarketing studies on OxyContin, Xtampza ER, and Hysingla ER. RESULTS Studies showed lower rates of abuse (19% reduction), opioid use disorder (27%), overdose (34%), and fatalities (85%) with the reformulated OxyContin when compared with the original product and comparator opioids. However, these studies revealed the potential for bypassing abuse-deterrent mechanisms and diverting abuse to other drugs. Postmarketing studies are unavailable for Xtampza ER or Hysingla ER, although premarketing studies suggested that some controlled-release properties persist when the product is manipulated, indicating that abuse may be more difficult and less rewarding. CONCLUSIONS Abuse-deterrent opioid products may lead to reductions in abuse, overdose, and overdose fatalities. However, cost, loopholes in deterrence mechanism, and possible diversion to other substances hinder their role in the opioid crisis. Multiple approaches must be used to improve opioid safety, and further postmarketing and real-world analyses should be performed on available opioid formulations to assess their impact on abuse-related adverse events.
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Affiliation(s)
- Shannon Gadd
- Department of Pharmacotherapy, College of Pharmacy, University of Utah
| | - Nicholas Cox
- Department of Pharmacotherapy, College of Pharmacy, University of Utah
- Department of Pharmacy, University of Utah Health
| | - James Samuelson
- Division of Epidemiology, Department of Internal Medicine, Program for Addiction Research, Clinical Care, Knowledge, and Advocacy, School of Medicine, University of Utah; and
| | - Amy Kenney
- Division of Epidemiology, School of Medicine, University of Utah, Salt Lake City, UT
| | - Kyle Turner
- Department of Pharmacotherapy, College of Pharmacy, University of Utah
- Department of Pharmacy, University of Utah Health
| | - Gerald Cochran
- Division of Epidemiology, Department of Internal Medicine, Program for Addiction Research, Clinical Care, Knowledge, and Advocacy, School of Medicine, University of Utah; and
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Quintens C, De Coster J, Van der Linden L, Morlion B, Nijns E, Van den Bosch B, Peetermans WE, Spriet I. Impact of Check of Medication Appropriateness (CMA) in optimizing analgesic prescribing: An interrupted time series analysis. Eur J Pain 2020; 25:704-713. [PMID: 33259703 DOI: 10.1002/ejp.1705] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Pain therapy in inpatients is regularly suboptimal and might be improved by clinical pharmacy services. In our hospital, we have implemented a software-supported 'Check of Medication Appropriateness' (CMA), which is a centralized pharmacist-led service consisting of a clinical rule-based screening for potentially inappropriate prescriptions (PIPs), and a subsequent medication review by pharmacists. We aimed to investigate the impact of the CMA on pain-related prescribing. METHODS A quasi-experimental study was performed in a large teaching hospital, using an interrupted time series design. Pre-implementation, patients were exposed to standard of care. Afterwards, a pain-focused CMA comprising 12 specific clinical rules pertaining to analgesic prescribing were implemented in the post-implementation period. A regression model was used to assess the impact of the intervention on the number of pain-related residual PIPs between both periods. The total number of recommendations and acceptance rate was recorded for the post-implementation period. RESULTS At baseline, a median number of 13.1 (range: 9.5-15.8) residual PIPs per day was observed. After the CMA intervention, the number was reduced to 2.2 (range: 0-9.5) per day. Clinical rules showed an immediate relative reduction of 66% (p < .0001) in pain-related residual PIPs. A significant decreasing time trend was observed during the post-implementation period. Post-implementation, 1683 recommendations were given over 1 year with an acceptance rate of 74.3%. CONCLUSIONS We proved that the CMA approach reduced the number of pain-related residual PIPs. More pharmacist involvement and the use of clinical rules during hospital stay should be further promoted to optimize appropriate prescribing of analgesics. SIGNIFICANCE Prescribing of analgesics should be improved in inpatients to optimize pain control and to reduce iatrogenic harm. The Check of Medication Appropriateness (CMA) approach, comprising a clinical rule-based screening for patients at risk and a targeted medication review by pharmacists, reduced the number of pain-related potentially inappropriate prescriptions in a highly significant and sustained manner. This study presents the opportunities of a centralized clinical pharmacy service to help clinicians to further improve analgesic prescribing.
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Affiliation(s)
- Charlotte Quintens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.,Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
| | - Johan De Coster
- Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - Lorenz Van der Linden
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.,Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
| | - Bart Morlion
- Leuven Centre for Algology & Pain Management, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Egon Nijns
- Department of Information Technology, University Hospitals Leuven, Leuven, Belgium
| | - Bart Van den Bosch
- Department of Information Technology, University Hospitals Leuven, Leuven, Belgium.,Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Willy E Peetermans
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.,Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Isabel Spriet
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.,Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
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Dayer LE, McDade ER, Harrington S. Pharmacist-Delivered Patient Care in an Interdisciplinary Team-Based Institutional Palliative Care Clinic, 2012 to 2018. J Palliat Care 2019; 36:188-193. [PMID: 31496358 DOI: 10.1177/0825859719869614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Palliative care services offered in the United States have grown substantially since the year 2000. These types of services have been shown to improve a patient's quality of life when presented with a serious or life-threatening disease or illness. An important characteristic of a quality palliative care service is the presence of an interdisciplinary team to utilize different areas of expertise to address multiple aspects of patient care. An important member of this team is the pharmacist. The services presented in this interprofessional education and practice guide describe pharmacist-delivered palliative care services offered in an institutional ambulatory palliative care setting from 2012 to 2018.
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Affiliation(s)
- Lindsey E Dayer
- Department of Pharmacy Practice, 12215University of Arkansas for Medical Sciences College of Pharmacy, Markham, Little Rock, AR, USA
| | - Elizabeth R McDade
- Department of Pharmacy Practice, 12215University of Arkansas for Medical Sciences College of Pharmacy, Knoxville, TN, USA
| | - Sarah Harrington
- Division of Palliative Medicine, Department of Internal Medicine, 12215University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, USA. Dayer is now with UT Medical Center, Knoxville, TN, USA
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