Pilot of a pharmacist‐integrated interprofessional team to optimize prescribing in a telemedicine palliative care clinic

Abstract

AbstractIntroductionThe rapidly growing number of frail elderly patients is leading to a greater need for palliative care services. Palliative care clinical pharmacy specialists (CPSs) can improve quality of care through comprehensive symptom and medication management. Incorporating pharmacists into palliative care through telemedicine meets complex pharmacotherapy needs of Veterans who have difficulty accessing care due to advanced illness.ObjectivesThe primary objective of this quality improvement project was to pilot a pharmacist‐integrated palliative care team clinic utilizing telemedicine to optimize palliative prescribing for Veterans and to describe CPS outcomes related to pharmacotherapy changes implemented. A secondary outcome was to assess Veteran satisfaction with assessments completed via telephone post visit.MethodsA CPS was integrated into the existing palliative care team beginning December 1, 2019 with video and audio telemedicine clinic appointments offered through May 31, 2020. The CPS completed comprehensive medication regimen reviews, assessed symptoms, and addressed medication‐related concerns during the visit. Recommendations for deprescribing opportunities and symptomatic management were provided to the consulting provider and/or primary treatment team. Recommendations made and those implemented within 30 days of the appointment were documented. Veteran satisfaction assessments were completed via telephone 14‐30 days after the clinic visit.ResultsThe palliative care team integrated a CPS and completed 25 consults via telemedicine technology between December 2019 and May 2020. The pharmacotherapy implementation rate was 60% (119/200) including a deprescribing rate of 57% (72/126), decreasing polypharmacy and potentially resulting in a decrease in adverse drug events. Veterans were on average very satisfied with their visit, with an assessment response rate of 56% (14/25).ConclusionPharmacist involvement with the palliative care team decreased polypharmacy, optimized symptom management, and increased use of telemedicine technology. Veterans were overall satisfied with the care received by the palliative care team via telemedicine technology.