Development of PharmPAL: A Collaborative Practice Pharmacy Clinic in an Ambulatory Palliative Care Clinic

• Published in: Journal of pain and symptom management Vol. 63; no. 5; p. 860
• Main Authors: Bacon, Molly, Kematick, Benjamin, Scullion, Bridget, Lally, Kate, Suliman, Iman
• Format: Journal Article
• Language: English
• Published: Madison Elsevier Inc 01-05-2022; Elsevier Limited
• Subjects: Availability; Clinical outcomes; Collaboration; Counseling; Drug stores; Drugs; Health education; Interdisciplinary aspects; Medical referrals; Outpatient care facilities; Palliative care; Patient satisfaction; Patients; Pharmacists; Pharmacy; Polls & surveys; Prescribing; Symptom management; Visits
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2022.02.044

1. Review the roles of palliative care pharmacists in the outpatient clinic setting
2. Summarize current practice models in the outpatient palliative care setting
3. Outline the development of PharmPAL and overall clinic metrics
Pharmacists play several roles in the outpatient palliative care setting, and their involvement in patient care is associated with improved patient safety and clinical outcomes. At Dana-Farber we have two primary ways that our embedded palliative care pharmacists are involved in clinical care. Pharmacists have participated in co-visits with the primary clinician since 2001, primarily providing suggestions about medication management. In July 2020 a collaborative drug therapy management clinic called PharmPAL was piloted. PharmPAL allows credentialed pharmacists to lead follow-up palliative care visits encompassing patient assessments, counseling, education, ordering of laboratory tests, and prescribing and management of medication regimens.
The goal of PharmPAL is to support the palliative care clinic by increasing the availability of follow-up care to patients with intensive symptom management needs. We aimed to determine whether clinicians were satisfied with this pilot or whether it hindered interdisciplinary care by decreasing pharmacist availability for co-visits.
Surveys were disseminated to assess clinician satisfaction with the various models of pharmacist support, and we used that feedback to plan future pharmacist support of the palliative care clinic.
Primary reasons for PharmPAL referral included new consult requiring close follow-up, education, and counseling, stable patient for refill review, schedule availability, and patients with recent or anticipated medication changes. The main barriers to using PharmPAL involved pharmacist availability. Based on an overwhelming percentage of providers in favor of increasing PharmPAL visits, the weekly availability increased from eight 30-minute appointments per week to twelve 30-minute appointments each week.
Increased PharmPAL availability led to a 38% increase in patient encounters in the PharmPAL clinic and an increase in outpatient clinic volume overall. Additional surveys are used to address feedback for ongoing areas for improvement to continue increasing PharmPAL referrals and maintain overall provider satisfaction with pharmacy involvement.