Development of an Ambulatory Palliative Care Pharmacist Practice

Purpose: The roles of a pharmacist in hospice and inpatient palliative care settings have been described. However, no reports of a palliative care pharmacist in an ambulatory care setting have been published. Our objective was to establish a model for incorporating an outpatient clinical pharmacist as part of a multidisciplinary palliative care team. Methods: A palliative care pharmacist based out of a retail pharmacy was incorporated as part of a consultative ambulatory palliative care service (known as the Doris A. Howell Service) at the University of California, San Diego Moores Cancer Center. The pharmacist completed all legal requirements to prescribe under a collaborative practice agreement in California (including National Provider Identifier [NPI] and US Drug Enforcement Agency [DEA] US Drug Enforcement Agency (DEA) registration). Results: From November 2006 through August 2007, the palliative care pharmacist consulted 29 new patients (the average age of patients was 49; range, 20-78 years) who had 114 clinic visits. The most common reason for referral to the palliative care pharmacist was for pain management (27/29; 93%). During the 114 patient clinic visits, 98% (112/114) of the palliative care pharmacist medication recommendations were accepted by the primary care oncologist. Physicians completed a satisfaction survey and reported that the top three useful activities of the Howell Service were: additional time spent with patients without physician present (90.9%), pain and symptom management (81.8%), and psychosocial support (72.7%). Conclusion: This is the first report of a palliative care pharmacist in a retail-based ambulatory care setting. Initial results demonstrate the success of this pilot program.