Positive patient outcomes, including a decrease in pain and constipation, were reported as a result of a pharmacist-physician collaboration in a palliative care outpatient practice.
“With continued follow-up visits, the patients in the study cohort sustained a 30% decrease in pain score,” according to Joseph D. Ma, PharmD.
Researchers from the Skaggs School of Pharmacy and Pharmaceutical Sciences at the University of California San Diego had previously described the development and initial achievement of a pharmacist-led outpatient palliative care practice conducted at a single academic comprehensive cancer center. The research team, composed of physicians and pharmacists, conducted physician-completed satisfaction surveys (n=11) and reported that the most valuable actions performed by pharmacists were time spent with patients without a physician present (91%) and recommendations for pain and symptom management (82%). The new research illustrates the effect on patients of the same pharmacist-physician collaboration.
The role of pharmacists and the symptom management interventions they provide have been demonstrated in several studies of outpatient palliative and/or supportive care practices. However, Ma and colleagues desired to expand the research to incorporate and evaluate patient outcomes from the pharmacist-led outpatient palliative care practice and found that the outcome was desirable. Their findings were presented in a poster at the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology 2014 annual meeting, held in Miami, Florida.
Patient Composition, Pharmacist Training, and Data Analysis
A retrospective data analysis was conducted on a cohort of 84 new adult patients and 272 follow-up consultations from 2011 to 2012. Patients were referred by an oncologist and/or hematologist to the Doris A. Howell outpatient palliative care consultation service. New patients were allocated 60 minutes for a consultation, whereas existing patients arriving weekly to monthly for follow-up visits were given 30 minutes of consultation time. The majority of patients had a diagnosis of cancer (most commonly, gastrointestinal malignancy), and their consultations encompassed pain management, other physical symptoms, and conversations about goals of care.
“The patients gave the pharmacists a whole host of other information. They felt like we were having a real discussion with them,” Ma said in an interview with The Oncology Pharmacist. “They enjoyed the pharmacists’ presence.”
The pharmacists were allied health professional staff at the University of California San Diego Medical Center and had completed palliative medicine didactic training and postgraduate training. Pharmacists in the study had independent prescriptive authority in accordance with California law, were licensed by the Drug Enforcement Administration, and held National Provider Identifier status.
During the course of research, pharmacists were allowed to measure, start, stop, and/or adjust therapy for pain management, nausea, emesis, and any symptoms of side effects from drug treatment. The scope of the pharmacists’ prescriptive authority included Schedule II controlled substances for treatment of pain and other physical ailments. All treatment was performed under the supervision of a physician.
“Pain scores can decrease for a variety of reasons that we don’t know of,” said Ma. “But we were able to establish a collaborative practice protocol which allowed us as pharmacists to see patients more consistently while being more aggressive toward modifying their therapy. If we started a patient on a pain medication, instead of saying, ‘See you in a month,’ we’d say we wanted to talk to them ‘in a couple of days.’ ”
Ma and colleagues measured average pain score fluctuations at baseline (ie, initial visit) compared with follow-up visits. Frequencies were given as to the number of patients who reached a decrease in their pain score that was clinically relevant, or a 30% reduction in pain score compared with their first visit.
Significant Decrease in Pain Scores
Researchers found that mean pain scores decreased significantly from follow-up visits 2 through 5 (P .005). During successive follow-up visits, the percentage of patients with a 30% decrease in pain score escalated. Patient-reported occurrence of constipation and nausea and vomiting lessened with follow-up appointments (P > .005). However, there was no change in patient-reported insomnia and dyspnea between the initial visit and follow-up visits (P > .005).
Pharmacist-Physician Collaboration Found Successful
Ma and colleagues concluded that a pharmacist-physician collaboration in a palliative care outpatient practice was effective in decreasing cancer patients’ pain symptoms and constipation. With continued follow-up visits, the patients in the study cohort sustained a 30% decrease in pain score. The researchers stated that “outpatient palliative care practices should include pharmacists, with prescribing authority, as part of a trans-disciplinary approach to care for patients with serious illness.”
Ma JD, Roeland EJ, Mitchell WM, et al. Patient outcomes of a pharmacist-physician collaboration in a palliative care outpatient setting. Presented at: 2014 Annual Meeting of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology; June 26-28, 2014; Miami, FL. Abstract 0151.