Impact of pharmacist intervention on clinical outcomes in the palliative care setting

Background: Although accepted as an integral part of the interdisciplinary team, pharmacist value in palliative care has predominantly been evaluated by subjective methods. This study was conducted to identify factors that impact physician acceptance of the pharmacist's recommendation and to determine whether acceptance is a significant predictor of clinical outcome. Methods: As a mandated in-house quality assurance project at Niagara Hospice, Inc, 2 clinical pharmacists tracked each request for pharmacotherapeutic intervention over a 4-month period (April-July 2009). Through retrospective examination of clinical notes, each intervention was reviewed to determine age, gender, death date, presenting symptom, recommending pharmacist, recommendation type, recommendation status (accepted vs declined), and clinical outcome (achieved vs not achieved). Results: Overall, 89.4% of recommendations were accepted, and 79.9% of patients achieved the desired clinical outcome. With the exception of delirium as a presenting symptom (75% accepted vs 90.8% all other symptoms accepted; P = .02), no significant associations were identified between any variable and recommendation acceptance. Multivariate analysis revealed acceptance of the pharmacist's recommendation (OR, 19.0; 95% CI, 7.10-50.93; P < .001), the recommending pharmacist (resident, OR, 2.46; 95% CI, 1.18-5.12; P = .02), and closer proximity to death (day 0-30, OR, 2.79; 95% CI, 1.16-6.70; P = .02) to be significant predictors of achieving the desired clinical outcome. Conclusion: None of the included variables significantly influenced the physician's decision to accept or decline the pharmacist's recommendation. Acceptance of the pharmacist's recommendation was significantly associated with the strongest predictor of the patient achieving the desired clinical outcome.