Impact of pharmacist intervention on clinical outcomes in the palliative care setting.
BACKGROUND
Although accepted as an integral part of the interdisciplinary team, pharmacist value in palliative care has predominantly been evaluated by subjective methods. This study was conducted to identify factors that impact physician acceptance of the pharmacist's recommendation and to determine whether acceptance is a significant predictor of clinical outcome.


METHODS
As a mandated in-house quality assurance project at Niagara Hospice, Inc, 2 clinical pharmacists tracked each request for pharmacotherapeutic intervention over a 4-month period (April-July 2009). Through retrospective examination of clinical notes, each intervention was reviewed to determine age, gender, death date, presenting symptom, recommending pharmacist, recommendation type, recommendation status (accepted vs declined), and clinical outcome (achieved vs not achieved).


RESULTS
Overall, 89.4% of recommendations were accepted, and 79.9% of patients achieved the desired clinical outcome. With the exception of delirium as a presenting symptom (75% accepted vs 90.8% all other symptoms accepted; P = .02), no significant associations were identified between any variable and recommendation acceptance. Multivariate analysis revealed acceptance of the pharmacist's recommendation (OR, 19.0; 95% CI, 7.10-50.93; P < .001), the recommending pharmacist (resident, OR, 2.46; 95% CI, 1.18-5.12; P = .02), and closer proximity to death (day 0-30, OR, 2.79; 95% CI, 1.16-6.70; P = .02) to be significant predictors of achieving the desired clinical outcome.


CONCLUSIONS
None of the included variables significantly influenced the physician's decision to accept or decline the pharmacist's recommendation. Acceptance of the pharmacist's recommendation was significantly associated with the strongest predictor of the patient achieving the desired clinical outcome.
University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY, USA. shelleywilson1@gmail.com
Shelley
S
Wilson
Robert
R
Wahler
Jack
J
Brown
Fred
F
Doloresco
Scott V
SV
Monte
D001291:Attitude of Health Personnel; D006801:Humans; D007400:Interprofessional Relations; D055118:Medication Adherence; D010166:Palliative Care / Q000379:methods*; D010348:Patient Care Team / Q000458:organization & administration*; D010593:Pharmaceutical Services; D010595:Pharmacists / Q000458:organization & administration*; D024382:Professional Role; D012189:Retrospective Studies; D014481:United States