title: Retrospective analysis of pharmacist interventions in an ambulatory palliative care practice.
abstract: BACKGROUND
  We have previously reported the development of an outpatient palliative care practice under pharmacist-physician collaboration. The Doris A. Howell Service at the University of California, San Diego Moores Cancer Center includes two pharmacists who participate in a transdisciplinary clinic and provide follow-up care to patients.
  
  
  OBJECTIVE
  This study evaluated pharmacist interventions and patient outcomes of a pharmacist-led outpatient palliative care practice.
  
  
  METHODS
  This was a retrospective data analysis conducted at a single, academic, comprehensive cancer center. New (first visit) patient consultations were referred by an oncologist or hematologist to an outpatient palliative care practice. A pharmacist evaluated the patient at the first visit and at follow-up (second, third, and fourth visits). Medication problems identified, medication changes made, and changes in pain scores were assessed.
  
  
  RESULTS
  Eighty-four new and 135 follow-up patient visits with the pharmacist occurred from March 2011 to March 2012. All new patients (n = 80) were mostly women (n = 44), had localized disease (n = 42), a gastrointestinal cancer type (n = 21), and were on a long-acting (n = 61) and short-acting (n = 70) opioid. A lack of medication efficacy was the most common problem for symptoms of pain, constipation, and nausea/vomiting that was identified by the pharmacist at all visits. A change in pain medication dose and initiation of a new medication for constipation and nausea/vomiting were the most common interventions by the pharmacist. A statistically significant change in pain score was observed for the third visit, but not for the second and fourth visits.
  
  
  CONCLUSIONS
  A pharmacist-led outpatient palliative care practice identified medication problems for management of pain, constipation, and nausea/vomiting. Medication changes involved a change in dose and/or initiating a new medication. Trends were observed in improvement and stabilization of pain over subsequent clinic visits.
authors.affiliation: Skaggs School of Pharmacy & Pharmaceutical Sciences, University of California (UC), San Diego, La Jolla, CA, USA UC San Diego, Moores Cancer Center, La Jolla, CA, USA.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Ma
authors.affiliation: Skaggs School of Pharmacy & Pharmaceutical Sciences, University of California (UC), San Diego, La Jolla, CA, USA.
authors.forename: Victor
authors.initials: V
authors.lastname: Tran
authors.affiliation: Skaggs School of Pharmacy & Pharmaceutical Sciences, University of California (UC), San Diego, La Jolla, CA, USA.
authors.forename: Carissa
authors.initials: C
authors.lastname: Chan
authors.affiliation: UC San Diego, Moores Cancer Center, La Jolla, CA, USA.
authors.forename: William M
authors.initials: WM
authors.lastname: Mitchell
authors.affiliation: Skaggs School of Pharmacy & Pharmaceutical Sciences, University of California (UC), San Diego, La Jolla, CA, USA UC San Diego, Moores Cancer Center, La Jolla, CA, USA ratayee@ucsd.edu.
authors.forename: Rabia S
authors.initials: RS
authors.lastname: Atayee
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000379:methods*; D000700:Analgesics / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D003299:Cooperative Behavior; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D010166:Palliative Care / Q000379:methods*; D010595:Pharmacists; D010820:Physicians; D024382:Professional Role; D012189:Retrospective Studies
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid
keywords: Pharmacist; oncology; pain clinic; palliative