Retrospective analysis of pharmacist interventions in an ambulatory palliative care practice

Joseph, D.; Tran, Victor; Chan, Carissa; Mitchell, William M.; Atayee, Rabia S.

doi:10.1177/1078155215607089

Cited by 43 publications

(51 citation statements)

References 37 publications

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“…After reviewing the titles and abstracts, 617 records were excluded because they did not include a study of pharmacist interventions in adult patients with cancer; did not assess the impact of interventions; or included non‐ambulatory patients. The remaining 40 records were selected for full‐text examination, of which 11 met all the eligibility criteria and were included in this systematic review . The excluded studies and the reasons for their exclusion are detailed in Appendix 2.…”

Section: Resultsmentioning

confidence: 99%

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The effects of pharmacist interventions on adult outpatients with cancer: A systematic review

et al. 2017

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SummaryWhat is known and objectives: Most antineoplastic drugs are highly toxic and have low therapeutic indexes, which can result in drug-related problems. In this context, pharmacist interventions may play an important role in the success of the treatment.The objective of this study was to examine the effects of pharmacist interventions on adult outpatients with cancer using antineoplastic drugs. Methods:A literature search was performed using PubMed, ISI Web of Science and LILACS databases from January 1990 to April 2016, using MeSH terms or text words related to pharmacist interventions, cancer and outpatient care. Studies published in English, Portuguese or Spanish on the effects of pharmacist interventions in outcome measures in adult outpatients with cancer were included. Two independent authors performed study selection and data extraction with a consensus process. The articles were analysed according to previously established criteria, such as country, study design, setting, population, type of cancer, description of the intervention and control groups, outcomes, main conclusions and study limitations. Results and discussion:A total of 874 records were identified, of which 11 satisfied the inclusion criteria. The studies were conducted mainly in the United States and included patients aged >50 years. Most studies had a before-after design. Pharmacist interventions primarily included educating and counselling patients on the management of adverse events. Rates of nausea and vomiting control, medication adherence and patient satisfaction were the most common outcome measures; a significant benefit in these parameters as a result of pharmacist interventions was noted in most studies. What is new and conclusion:The findings from this systematic review indicate that pharmacist interventions can improve outcome measures in outpatients with cancer.However, the collective quality of the studies was poor and gaps identified indicate that further research is needed to provide more robust results. K E Y W O R D Scancer, pharmaceutical care, pharmacists, systematic review

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Section: Resultsmentioning

confidence: 99%

“…All studies were published in English and reported between 2012 and 2016. Sample size ranged from 12 to 249 individuals, with most studies including sample sizes smaller than 100 individuals (n=7) . In most studies (n=10), the mean age of patients was >50 years, and an equal proportion of men and women was recruited.…”

Section: Resultsmentioning

confidence: 99%

The effects of pharmacist interventions on adult outpatients with cancer: A systematic review

et al. 2017

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“…16,22,23 Wilson et al 23 reported that implementation of pharmacist recommendations in a palliative care setting was 1 of the strongest predictors of patients achieving desired outcomes. Because the purpose of this study was to evaluate the impact of a previsit pharmacist review, and in an attempt to evaluate an intervention that could feasibly be added to other current pharmacist clinic responsibilities, the pharmacists did not implement any of the intervention recommendations but rather deferred implementation to the prescriber.…”

Section: Discussionmentioning

confidence: 99%

“…The current literature on pharmacist engagement in chronic pain management is limited to specialty care settings (eg, palliative care), investigations of patient-centered medical home designation, or descriptive reports. 15,16,[22][23][24][25] To our knowledge, this is the first published study of the impact of a pharmacist-led intervention focused on comprehensive chronic pain management in a family medicine setting. The purpose of this study was to evaluate the impact of a previsit pharmacist review of highrisk patients treated with opioids for chronic noncancer pain for compliance with CDC recommendations at a family medicine residency clinic.…”

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confidence: 99%

“…[15][16][17][18][19][20][21] Because of the need for monitoring and clinician follow-up, the unique pharmacologic properties, and the potential for diversion, opioid therapy in chronic pain presents an opportunity for pharmacist involvement. The current literature on pharmacist engagement in chronic pain management is limited to specialty care settings (eg, palliative care), investigations of patient-centered medical home designation, or descriptive reports.…”

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confidence: 99%

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Impact of Pharmacist Previsit Input to Providers on Chronic Opioid Prescribing Safety

et al. 2018

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Introduction: Primary care providers (PCPs) account for half of opioid prescriptions, often feel chronic pain patients are challenging to manage, and there is wide variability in practice patterns. The purpose of this pilot study was to evaluate the impact of a previsit pharmacist review of high-risk patients treated with opioids for chronic pain on compliance to guideline recommendations at a family medicine residency clinic.Methods: All adult patients with an appointment for chronic pain who were prescribed >50 morphine milligram equivalents (MMEs)/day had charts reviewed by a pharmacist before each appointment; recommendations were sent electronically to the provider before the appointment. After 4 months of implementation, each patient's chart was manually reviewed to gather outcome variables. The primary outcomes were the mean MMEs/day and pain scores.Results: Pharmacist previsit recommendations were provided for 45 patients. When comparing outcomes before and after intervention, the mean MMEs/day decreased by 14% (P < .001), with no change in pain scores (P ‫؍‬ .783). Statistically significant improvements were noted in multiple other secondary opioid safety outcomes.

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Pharmacist intervention and anti‐platelet medication monitoring in patients following stroke and transient ischemic attack

Gréger

Wojcik

Westphal

et al. 2020

J Am Coll Clin Pharm

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IntroductionAspirin and clopidogrel are mainstays in secondary stroke prevention; however, some patients do not demonstrate optimal antiplatelet effects from these therapies.ObjectivesThe primary objective of this study was to determine if pharmacist medication intervention paired with anti‐platelet medication monitoring with whole blood aggregometry improved responsiveness to antiplatelet treatment when compared with standard‐of‐care, alone in patients at risk of recurrent stroke or transient ischemic attack (TIA).MethodsThis retrospective chart review at an outpatient neurology practice examined patients treated post‐stroke or post‐TIA between 2005 and 2017. Patients were categorized as either having undergone platelet function testing (PFT) with pharmacist intervention and standard‐of‐care or standard‐of‐care alone. Patient populations for each group were matched based on age, sex, and ABCD2 risk scores. Pharmacotherapeutic management and interventions were assessed in each group.ResultsA total of 342 patients were included as two matched groups (n = 171 for each group) with parallel baseline characteristics. Drug‐drug interactions were identified (P < .0001), and counseling on adherence (P = .0008) occurred statistically significantly more often with a pharmacist involved in patient care. After pharmacist intervention and PFT, 83% of patients were considered responsive to their antiplatelet therapy compared with 27% at baseline in the pharmacist intervention group (P < .0001).ConclusionPharmacist interventions optimized secondary stroke/TIA prophylaxis therapy, decreased drug‐drug interactions, and increased adherence counseling. Patients who underwent PFT and pharmacist intervention transitioned from nonresponsive to responsive to their antiplatelet therapy regimen.

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Retrospective analysis of pharmacist interventions in an ambulatory palliative care practice

Cited by 43 publications

References 37 publications

The effects of pharmacist interventions on adult outpatients with cancer: A systematic review

The effects of pharmacist interventions on adult outpatients with cancer: A systematic review

Impact of Pharmacist Previsit Input to Providers on Chronic Opioid Prescribing Safety

Pharmacist intervention and anti‐platelet medication monitoring in patients following stroke and transient ischemic attack

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