Laird Harrison

October 20, 2015

SAN FRANCISCO — The inclusion of pharmacists on palliative care teams can reduce pain and save money, according to results from a new study.

"The study shows the value of a collaborative approach in caring for patients at the end of life," said Dharma Naidu, PharmD, from the Community Hospital of the Monterey Peninsula in California.

"Previously, we might consult over the phone," he told Medscape Medical News. "Now we are sitting at the table."

Dr Naidu presented the study findings here at the American College of Clinical Pharmacy 2015 Global Conference.

A team-based approach to palliative care was introduced at the hospital in October 2013. As a group, a pharmacist, a physician, a nurse practitioner, a nurse, a social worker, and a chaplain meet and consult with dying patients and their families.

The pharmacist participates in palliative team rounds three times a week, and helps develop plans to address symptoms, advance care, and physician orders for a life-sustaining treatment paradigm.

 
Previously, we might consult over the phone. Now we are sitting at the table.
 

At the beginning of the team-based program, the pharmacist consulted on the cases of 23% of patients who died in the hospital. The hospital then instituted a policy of automatically alerting the pharmacist about patients receiving palliative care.

"If a physician is going to focus on end of life, it sends an automatic trigger," Dr Naidu explained.

These alerts led to an increase in pharmacist consultations — to 70%.

To see how effective the pharmacist was, Dr Naidu and his colleagues analyzed the records of patients who received a palliative medicine consult from November 1, 2013 to October 31, 2014.

The team extracted data from clinical notes on pharmacist palliative care activities, and documented pain and symptom management outcomes before and after pharmacist intervention. They also collected data on pharmacist recommendations for the discontinuation of medications and treatments, participation in family meetings, and advance care planning.

Of the 938 palliative consult orders, the palliative medicine pharmacist completed 853 consults and intervened in the care of 487 patients.

"A lot of the time is spent on symptom management and education. We used to have a single physician who did about 50% of this volume," Dr Naidu reported.

After the pharmacist intervention, there was a decrease in the average acute pain score of 2.6 points on a 10-point scale, and a decrease in the average chronic pain score of 2.8 points.

Less Pain, Fewer Symptoms

The pharmacist helped 91.0% of patients achieve documented pain goals and improve symptoms — from severe or moderate to mild or none — in 95.6% of patients with nausea, 90.0% of patients with dyspnea, and 90.0% of patients with anxiety.

The pharmacist made 481 recommendations for the discontinuation of medications or treatments that did not support palliative care goals. These included chemotherapy (2.7%), antimicrobials (15.0%), fluids and oral medications (53.0%), and laboratory tests (29.3%).

The researchers estimate that these discontinuation interventions saved $100,000 in unnecessary medication.

However, to determine the effects of this approach more definitively would require a prospective trial, said Joseph DiPiro, PharmD, from the Virginia Commonwealth University School of Pharmacy in Richmond.

"I think pharmacists have been involved in palliative care for a long time," Dr DiPiro told Medscape Medical News. But in some states, these relationships are being formalized in collaborative practice agreements, he pointed out.

This study was funded internally. Dr Naidu and Dr DiPiro have disclosed no relevant financial relationships.

American College of Clinical Pharmacy (ACCP) 2015 Global Conference: Abstract 198. Presented October 19, 2015.

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