Ma Joseph D, Tran Victor, Chan Carissa, Mitchell William M, Atayee Rabia S
Skaggs School of Pharmacy & Pharmaceutical Sciences, University of California (UC), San Diego, La Jolla, CA, USA UC San Diego, Moores Cancer Center, La Jolla, CA, USA.
Skaggs School of Pharmacy & Pharmaceutical Sciences, University of California (UC), San Diego, La Jolla, CA, USA.
J Oncol Pharm Pract. 2016 Dec;22(6):757-765. doi: 10.1177/1078155215607089. Epub 2015 Oct 1.
We have previously reported the development of an outpatient palliative care practice under pharmacist-physician collaboration. The Doris A. Howell Service at the University of California, San Diego Moores Cancer Center includes two pharmacists who participate in a transdisciplinary clinic and provide follow-up care to patients.
This study evaluated pharmacist interventions and patient outcomes of a pharmacist-led outpatient palliative care practice.
This was a retrospective data analysis conducted at a single, academic, comprehensive cancer center. New (first visit) patient consultations were referred by an oncologist or hematologist to an outpatient palliative care practice. A pharmacist evaluated the patient at the first visit and at follow-up (second, third, and fourth visits). Medication problems identified, medication changes made, and changes in pain scores were assessed.
Eighty-four new and 135 follow-up patient visits with the pharmacist occurred from March 2011 to March 2012. All new patients (n = 80) were mostly women (n = 44), had localized disease (n = 42), a gastrointestinal cancer type (n = 21), and were on a long-acting (n = 61) and short-acting (n = 70) opioid. A lack of medication efficacy was the most common problem for symptoms of pain, constipation, and nausea/vomiting that was identified by the pharmacist at all visits. A change in pain medication dose and initiation of a new medication for constipation and nausea/vomiting were the most common interventions by the pharmacist. A statistically significant change in pain score was observed for the third visit, but not for the second and fourth visits.
A pharmacist-led outpatient palliative care practice identified medication problems for management of pain, constipation, and nausea/vomiting. Medication changes involved a change in dose and/or initiating a new medication. Trends were observed in improvement and stabilization of pain over subsequent clinic visits.
我们之前报道了在药剂师与医生合作下开展的门诊姑息治疗实践。加利福尼亚大学圣地亚哥分校穆尔斯癌症中心的多丽丝·A·豪厄尔服务项目包括两名药剂师，他们参与跨学科诊所并为患者提供后续护理。
本研究评估了由药剂师主导的门诊姑息治疗实践中，药剂师的干预措施及患者的治疗结果。
这是一项在单一学术性综合癌症中心进行的回顾性数据分析。新（首次就诊）患者咨询由肿瘤学家或血液学家转介至门诊姑息治疗实践。一名药剂师在首次就诊及后续（第二次、第三次和第四次就诊）对患者进行评估。评估所发现的用药问题、所做的用药调整以及疼痛评分的变化。
2011年3月至2012年3月期间，药剂师对84名新患者和135名患者进行了随访。所有新患者（n = 80）大多为女性（n = 44），患有局限性疾病（n = 42），为胃肠道癌症类型（n = 21），且正在使用长效（n = 61）和短效（n = 70）阿片类药物。在所有就诊中，药剂师确定缺乏药物疗效是疼痛、便秘和恶心/呕吐症状最常见的问题。调整止痛药物剂量以及开始使用治疗便秘和恶心/呕吐的新药是药剂师最常见的干预措施。第三次就诊时疼痛评分有统计学显著变化，但第二次和第四次就诊时未观察到。
由药剂师主导的门诊姑息治疗实践确定了用于管理疼痛、便秘和恶心/呕吐的用药问题。用药调整包括剂量变化和/或开始使用新药。在后续门诊就诊中观察到疼痛有改善和稳定的趋势。
