Jamila Negatu / Monday, January 22, 2018

Motivated pharmacy pioneers wanted

Palliative care is a subspecialty of internal medicine that focuses on providing relief from the symptoms and stress associated with a serious illness. The goal is to improve quality of life for both the patient and their family. People with chronic illness often have a high symptom burden, whether that is cancer-related pain, nausea and vomiting, dyspnea, constipation, or delirium.

By 2025, according to the Partnership to Fight Chronic Disease, it is estimated that 49% of the American population will have a chronic medical condition. Those with chronic medical conditions are the most frequent health care utilizers, accounting for 81% of hospital admissions and 91% of prescriptions filled; medications are involved in 80% of all treatments. All of these facts make it increasingly important that a pharmacist’s evaluation and treatment plan is taken into consideration when caring for this high-need, high-cost patient population.

My practice

I have been practicing under a collaborative practice agreement with palliative care providers since 2011. I am involved in direct patient care under this agreement to manage patients’ symptoms (pain and non-pain) and coordinate patients’ care on a daily basis. Because pharmacists are not currently a billable provider, some consideration has to be given to this during the normal course of daily planning.

Optimizing reimbursement lends to offsetting costs associated with the provision of this specialized care. When consult volume is low, I may see patients in conjunction with a nurse practitioner or physician and provide my oversight of the patient through formal recommendations to my team members. When consult volume is high, I will see these patients independently under the guidelines of my agreement. I rotate on call with the other provider team members.

I am involved in the development of clinical guidelines that affect the palliative care patient population, such as palliative sedation, provision of comfort care, or use of ketamine in refractory pain. Educating student pharmacists, medical students, residents, fellows, nurses, nurse practitioners, physicians, patients, and patients’ families is also part of my role. I co-lead the palliative care clinical consensus group for our system. This group is in charge of standardizing patient care across our specialty.

Collaborative practice agreements

Entering into a given practice requires a needs-assessment to be completed by the pharmacist to identify the most valuable use of their skills. Physician providers and nurse practitioners are unable to identify these needs because they may not know of the array of benefits the pharmacist brings to the care equation. Many are unaware that a pharmacist can participate under a collaborative practice agreement in 48 of 50 states. The scope of the participation varies by state.

There are currently seven states that consider pharmacists “mid-level providers” and thus grant licensing authority to certain categories of scheduled substances through the Drug Enforcement Administration. This status provides varying degrees of prescribing, procuring, or dispensing authority specified individually by state. Six of these seven states offer the opportunity for pharmacists to prescribe CIIs. All health professionals are encouraged to practice at the top of their license, so if these opportunities are available when you become a practitioner, incorporating them into your practice is highly encouraged.

Move the profession forward

In 2016, according to the Center to Advance Palliative Care, only about 9% of all hospitals reported having a pharmacist who participated on their team. This must change.

Students who are interested in this area of practice can prepare by seeking clinical rotations at local health care systems. Once the decision is made to move forward in this area of practice, completing a PGY1 and then PGY2 in palliative care and pain management is the recommended pathway. There are currently 17 palliative care and pain management residencies across the nation in some phase of the accreditation process.

A second way to prepare is by joining the Society of Palliative Care Pharmacists at www.palliativepharmacist.org.  The society’s mission is to promote education, development, and research in collaboration with the transdisciplinary team. Membership provides access to tools and resources to support practice, networking opportunities with other pharmacists already practicing in these areas, and employment opportunities posted on the website. Membership also provides leadership opportunities, as one student member is elected each year to sit on the Board of Trustees.

Additionally, APhA has a Pain, Palliative Care and Addiction SIG that student pharmacists can participate in.

Palliative care is a fairly young and rapidly growing field of practice for pharmacists. The profession is in need of motivated, highly-trained pharmacist pioneers to continue to move the profession’s role in this arena forward.

1652 Rate this article:

No rating

Tags: Student Magazine

Transitions Magazine

Motivated pharmacy pioneers wanted

My practice

Collaborative practice agreements

Move the profession forward

Please login or register to post comments.