Clinical pharmacy services in a home-based palliative care program

Abstract

Palliative care is designed to provide pain relief for and improve the quality of life of patients with a life-threatening illness.1 The number of patients with chronic, slowly debilitating illnesses, such as heart disease and end-stage lung disease, is on the rise, and most Americans with debilitating diseases prefer to die at home rather than in a hospital.2 Health care systems are expanding to accommodate these wishes. The number of formal palliative care programs is growing rapidly, with the most documented growth in the number of inpatient palliative care programs.3 Home-based palliative care programs are less common; however, some programs have been described.4,5 Palliative and hospice care share many similar goals. Both aim to address physical, emotional, and spiritual aspects of the patient’s life. However, several differences are apparent between these two types of patient care programs. Most hospice rules are determined by the regulations set by the federal government under Medicare. Patients must meet specific criteria to qualify for hospice and for hospice agencies to receive payment from the federal government. These criteria may vary depending on the patient’s diagnosis but could include a certain amount of weight loss or a particular functional status. One of the criteria for all patients enrolled in hospice care is a life expectancy of less than six months. Hospice care focuses on providing patient comfort after life-extending interventions are no longer appropriate or desired. On the other hand, palliative care can be provided during any stage of the illness, even while life-extending treatments, such as chemotherapy, are being pursued. Therefore, palliative care applies to a larger patient population, including those who do not desire or are not eligible for hospice services.