Pharmacist-Led, Interdisciplinary Model for Delivery of Supportive Care in the Ambulatory Cancer Clinic Setting

Abstract

Purpose: To describe a pharmacist-led, interdisciplinary method of care delivery begun at the University of North Carolina. We describe the characteristics of the population seen and the role of the individual members of the interdisciplinary team, and provide an early analysis of the program's impact on symptom improvement. Methods:A supportive care consultation service was begun at the University of North Carolina Hospitals to serve adult outpatients with cancer undergoing treatment or follow-up. Patients data were entered into an institutional review board-approved database to permit detailed assessments over time. Patient demographics were analyzed using descriptive statistics, medications used and changes made were noted, and symptom scores from a previously described instrument were captured and compared over time. Results:Patients were seen from all adult oncology services, including gynecologic, radiation, medical, and surgical. The characteristics of the population seen were similar to those of the hospital population as a whole. Most of the patients were seen for pain management, and many required a medication change. Symptom scores improved by the second visit, and the improvement was maintained. Conclusion:We are able to demonstrate that the use of a pharmacist-led, interdisciplinary team produced an improvement in symptom scores comparable to what has been seen in the inpatient palliative care service within our institution. Projected shortages of oncology providers may be mitigated by pharmacists working in collaborative practices, with prescriptive authority, in the ambulatory oncology setting.

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

“…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.…”

“…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.…”

Implementation of the Pharmacy Practice Model Initiative within comprehensive cancer centers

“…The progressive use of oncology pharmacists at the Duke and University of North Carolina Lineberger/North Carolina Cancer Hospitals has proven the value of pharmacists in optimizing healthcare efficiency in the outpatient setting. [9][10][11][12] In these facilities, pharmacists have developed over 200 chemotherapy order sets and initiated outpatient supportive care services focusing on patient education and cancer symptom management. These services have effectively reduced the time physicians spend writing medication orders.…”

Why aren't pharmacists included as prescribers in the Controlled Drugs and Substances Act?

“…3 Similar strategies are also employed in the United States; for example, at the University of north carolina, a pharmacist-led team focuses on pain management for oncology patients. 4 Under the collaborative practice agreement, the pharmacist prescribes medications, including narcotics. the resulting interventions have improved symptom scores and benefitted the patient population in this facility.…”

“…the resulting interventions have improved symptom scores and benefitted the patient population in this facility. 4 the idea of pharmacists prescribing controlled drugs has progressed one step further in the United Kingdom. In 1997, the UK government established a review of prescription supplies and administration of medicines.…”