Journal of Pain & Palliative Care Pharmacotherapy. 2014;28:212–215. Copyright © 2014 Informa Healthcare USA, Inc. ISSN: 1536-0288 print / 1536-0539 online DOI: 10.3109/15360288.2014.938884
REPORT
Evaluation of Clinical Pharmacy Services Offered for Palliative Care Patients in Qatar Kyle John Wilby, Alaa Adil Mohamad, and Sumaya AlSaadi AlYafei AB STRACT Palliative care is an emerging concept in the countries of the Gulf Cooperation Council, a political and economic union of Arab states bordering the Persian Gulf, namely Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates. Clinical pharmacy services have not yet been evaluated in this region. The objectives of this study were to create a baseline inventory of clinical pharmacy interventions in palliative care and to assess the perceived importance of interventions made. This was a prospective, single-center characterization study. Interventions were documented from September 30 to December 1, 2013. They were characterized into predetermined categories and analyzed using descriptive statistics. Physician acceptance rate and intervention rate per patient were calculated. Classification categories were sent to 10 practicing pharmacists in each of Qatar and Canada, who ranked the categories on the basis of perceived importance. A total of 96 interventions were documented, giving 3 interventions per patient and an acceptance rate of 81%. Discontinuing therapy (29%), initiating therapy (25%), and provision of education/counseling (13.5%) were most common. No differences were found between rankings from pharmacists in Qatar or Canada. Clinical pharmacy interventions are frequent, and those relating to alterations in drug therapy are most common. Interventions align with the perceived importance from pharmacists in both Qatar and Canada. KEYWORDS clinical pharmacy, hospice, palliative care, pharmacy, pharmacy education
pilot data on evaluating the benefit and effectiveness of services offered.4–8 However, no report was identified from a center in the Middle East or Gulf Cooperation Council (GCC). The GCC is a political and economic union of Arab states bordering the Persian Gulf, namely, Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates. The State of Qatar is rapidly becoming a regional and international leader for health care modernization and reform. A National Cancer Strategy was published that lists numerous objectives and key performance indicators to achieve from 2011 through 2016.9 Although ambitious, this strategy represents the best-known practices relevant to cancer care. Palliative care is a component of the strategy, and a multidisciplinary team was recently established at the National Center for Cancer Care & Research in Doha (NCCCR). A clinical pharmacist has been designated as a core component of this team. In 2013, an academic cross-appointment was established between the College of Pharmacy at Qatar
INTRODUCTION Palliative care is a complex health discipline that requires extensive collaboration and teamwork between health professionals, patients, caregivers, and administrative support.1 Patients have complex needs and a goal-oriented, team-based care plan is required for achievement of the best possible outcomes.2 As palliative patients typically have complicated medication regimens that require frequent adjustment and monitoring, a clinical pharmacist is a highly desirable team member.3 Reports have been published that describe the role of a pharmacist in palliative care and provide Kyle John Wilby, BSP, ACPR, PharmD, is an Assistant Professor and Alaa Adil Mohamad is a Pharmacy Student, College of Pharmacy, Qatar University, Doha, Qatar. Sumaya AlSaadi AlYafei, PharmD, is Assistant Director of Pharmacy, National Center for Cancer Care & Research, Doha, Qatar. Funding for this study was provided by a Qatar University Internal Student Grant. Address correspondence to: Dr. Kyle John Wilby, PO Box 2713, College of Pharmacy, Qatar University, Doha, Qatar (E-mail: [email protected]).
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University and NCCCR in palliative care. The College of Pharmacy has two clinical programs (Bachelor of Science in Pharmacy and Doctor of Pharmacy), both of which are accredited by the Canadian Council for Accreditation of Pharmacy Programs (CCAPP).10 The cross-appointment designates faculty members to establish and maintain a clinical practice, as well as formally precept students on 4-week internships. Typically, the cross-appointment is on site for clinical work 2 days per week. With larger numbers of pharmacy schools in the GCC seeking foreign accreditation, it is likely that the cross-appointment model in Qatar will be adapted elsewhere. This role is particularly unique due to the goal of modernizing health care through Canadian-accredited practice standards. Therefore, it is of great regional and international importance to describe and evaluate the types of recommendations and interventions occurring as part of the palliative care practice. The primary objective of this study was to create a baseline inventory of clinical pharmacy interventions after establishment of an academic cross-appointment in palliative care. Other objectives were to assess the perceived importance of these interventions.
METHODS Data were collected throughout the study period of September 30, 2013, to December 1, 2013. A data collection tool was developed, for which all data were recorded (see Appendix). Data obtained included number of patients admitted to palliative care while study pharmacists were on service, actual or potential drug therapy problem, clinical pharmacist intervention for resolution of identified drug therapy problem, and acceptance by the prescriber, if applicable. Similar methods were described previously.11 Intervention forms were copied and distributed independently to two investigators. Both investigators classified each recommendation according to an adaptation of a published classification method.12 Results were compared and any discrepancy was resolved through discussion and consensus. Classified recommendations were analyzed using descriptive statistics. Average numbers of recommendations per patient and recommendation acceptance rates were calculated. Education-related recommendations/interventions were not included in the acceptance rate, as the pharmacist does not need to seek permission to perform education-related activities. In order to assess perceived importance of each type of recommendation, an online survey was developed using online survey software (SurveyMon C
2014 Informa Healthcare USA, Inc.
213
key). The survey was sent to a convenience sample of 10 practicing pharmacists in Qatar and 10 practicing pharmacists in Canada. Canadian pharmacists were chosen as an international benchmark for clinical pharmacy. Additionally, the College of Pharmacy at Qatar University is accredited by the Canadian Council for Accreditation of Pharmacy Programs (CCAPP)10 ; therefore, Canadian input is warranted. Pharmacists were asked to rank each recommendation type on a 10-point scale. The 10-point scale consisted of numbers from 1 to 10, with 10 representing the highest importance and 1 representing the lowest importance. No site-specific information or results were given to the pharmacists in advance. Results from the survey were combined and each question was given a median score. For a secondary analysis, results were stratified for country of practice. The Mann-Whitney U test was used to determine if differences existed between overall rankings for each question between pharmacists in Canada and Qatar. Results were deemed significant if P < .05.
RESULTS A total of 96 recommendations were documented throughout the study time period (based on 24 working days of the pharmacist). The pharmacist saw 32 patients during this time, and this resulted in an average intervention rate of 3.0 interventions per patient. After removing education-based interventions, the prescriber acceptance rate was 81%. The results of the intervention classification are given in Table 1. Interventions regarding the discontinuation of drug therapy were most common (29%), followed by interventions regarding initiation of drug therapy (25%). Referring to other health care professionals was the least common intervention (2%), which is not surprising due to the nature of the inpatient practice. The most common medications involved with pharmacist
TABLE 1. Classification of Clinical Pharmacy Recommendations in Palliative Care Classified category of recommendations Discontinuation of therapy Initiation of therapy Education or counseling Dosage Increase Change in route of administration or dosage form Change in dose frequency or schedule Dosage decrease Laboratory monitoring Referral to other consult services
Number (%) 28 (29.2) 24 (25.0) 13 (13.5) 10 (10.4) 8 (8.3) 5 (5.2) 3 (3.1) 3 (3.1) 2 (2.1)
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TABLE 2. Perceived Importance of Clinical Pharmacy Interventions in Palliative Care Recommendation category Initiation of drug therapy Discontinuation of drug therapy Adjusting doses Adjusting routes Patient education Diagnostic tests Nonpharmacological alternatives Adjusting schedules Physician/nurse education Laboratory monitoring Brand switches
Qatar Median Canada Median (range)a (range)a P value 10 (9–10) 10 (8–10)
10 (8–10) 10 (8–10)
.955 .758
10 (3–10) 8.5 (2–10) 10 (3–10) 9 (2–10) 9 (8–10)
8 (8–10) 10 (7–10) 10 (7–10) 7 (3–9) 9 (7–10)
.174 .397 1.000 .114 .918
8 (2–10) 10 (3–10)
8 (6–10) 10 (4–10)
.758 .918
9 (2–10) 6 (1–10)
7 (5–9) 8 (2–9)
.351 .837
a
Rankers were asked to rate each category of recommendations on a scale of 1 to 10, with 1 being not at all important and 10 being of highest importance.
interventions included metoclopramide, haloperidol, and fentanyl. All intervention types were ranked highly by pharmacists in both Qatar and Canada. The median and range for each question is given in Table 2. No significant differences existed between countries when rankings were compared, but the small sample size precluded detection of any meaningful differences. The most highly rated interventions were those regarding initiation and discontinuation of therapy, which matched the most commonly classified interventions in the unit.
DISCUSSION This study described an evaluation of clinical pharmacy services in palliative care in Qatar. To our knowledge, this is the first study to report on clinical pharmacy services in palliative care in the GCC and results are relevant to other countries in the region, as well as any country developing pharmacy services in palliative care. Additionally, the cross-appointment model described is useful for centers pursuing accreditation and attempting to integrate foreign performance standards into preexisting health care systems. The major finding of this study is the establishment of a baseline inventory of clinical pharmacy services in palliative care in Qatar. This inventory can be used as a benchmark to monitor and compare future initiatives, including expansion of pharmacy service and scope of practice. It also serves as an eval-
uation mechanism for the cross-appointment model in palliative care and may be used to justify the role of cross-appointments in other clinical areas. Finally, as palliative care teams become more common throughout the Middle East and abroad, the results of this study can be used as rationale for inclusion of a clinical pharmacist as an essential team member and can provide insight for the types of services they can offer. Although it is difficult to rank the perceived importance of interventions without being given patientspecific context, it was interesting that the categories of interventions most commonly documented by this study were ranked favorably by pharmacists in both Canada and Qatar. This is a significant finding, as practice should attempt to generally reflect which types of activities are deemed most useful. This is especially true for clinical pharmacy services, as pharmacists are largely able to tailor their practices according to which activities they prefer. For example, a pharmacist could focus solely on dosage and route of administration adjustments, instead of proactively suggesting changes in therapy. One surprising finding of this study was the de-emphasis of patient education documented as part of the clinical pharmacy services offered. However, this is likely explained by the fact the cross-appointed faculty member did not have Arabic language skills and the high majority of patients were native Arabic speakers. It can be speculated that patient education-related interventions would increased if the pharmacist could speak the primary language of the patients admitted to the service. Also, patient education occurred during the days the pharmacist was not present by covering pharmacy staff and this was not captured. Finally, due to the nature of palliative care, patient education activities may be less than those in other units. This study has limitations that should be addressed. First, it does not account for all services offered on this unit. Dispensary pharmacists may provide recommendations by identifying drug therapy problems from medication orders, or from direct contact with team members. Additionally, the crossappointed faculty member was on service 2 days per week and recommendations given by covering pharmacists were not documented. Secondly, the sample size of rankers was very low and precludes any meaningful comparisons between the countries. Future studies should attempt to have a larger number of rankers, as well as rankers from a variety of disciplines, including medicine, nursing, and palliative care patients. The major conclusions from this study are that clinical pharmacy services are being offered for palliative care patients in Qatar, with an emphasis on Journal of Pain & Palliative Care Pharmacotherapy
Report
initiating and discontinuing drug therapy; a crossappointed faculty member is effective at providing these services; and the services offered align with perceived importance from pharmacists in Qatar and Canada. Future studies should further assess the role of the pharmacist in palliative care, including team perceptions and measurable impacts on patient clinical outcomes. Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
REFERENCES [1] Hall P, Weaver L. Interdisciplinary education and teamwork: a long and winding road. Med Educ. 2001;35:867–875. [2] Hearn J, Higginson IJ. Do specialist palliative care teams improve outcomes for cancer patients? A systematic literature review. Palliat Med. 1998;12:317–332. [3] Strickland JM. An introduction to palliative pharmacy care. In Strickland JM, ed. Palliative Pharmacy Care, 1st ed. Bethesda, MD: American Society of Health-System Pharmacists; 2009:3–6. [4] Hussainy SY, Box M, Scholes S. Piloting the role of a pharmacist in a community palliative care multidisciplinary team: an Australian experience. BMC Palliat Care. 2011;10:16. [5] Ise Y, Morita T, Katayama S, et al. The activity of palliative care team pharmacists in designated cancer hospitals: a nationwide survey in Japan. J Pain Symptom Manage. 2014;47:588–593.
C
2014 Informa Healthcare USA, Inc.
215
[6] Norrstrom B, Cannerfelt I, Frid H, Roos K, Ramstrom H. Introduction of pharmaceutical expertise in a palliative care team in Sweden. Pharm World Sci. 2010;32:829–834. [7] Ryan N, Chambers C, Ralph C, England D, Cusano F. Evaluation of clinical pharmacists’ follow-up service in an oncology pain clinic. J Oncol Pharm Pract. 2013;19:151–158. [8] Wilson S, Wahler R, Brown J, Doloresco F, Monte SV. Impact of pharmacist intervention on clinical outcomes in the palliative care setting. Am J Hosp Palliat Care. 2011;28:316–320. [9] Supreme Council of Health. National Cancer Strategy 2011–2016. Available at: http://www.nhsq.info/strategy-goalsand-projects/national-cancer-strategy. Accessed April 10, 2014. [10] The Canadian Council for Accreditation of Pharmacy Programs (CCAPP). Accredited programs. Available at: http://www. ccapp-accredit.ca/accredited programs/. Accessed March 9, 2014. Accessed April 10, 2014. [11] Overhage JM, Lukes A. Practical, reliable, comprehensive method for characterizing pharmacists’ clinical activities. Am J Health Syst Pharm. 1999;56:2444–2450. [12] Pharmaceutical Society of Australia. Pharmacists performing clinical interventions. Document DRP and recommendation classification codes. Available at: http://www.psa.org.au/ supporting-practice/professional-practice-standards/clinicalinterventions. Accessed August 31, 2013. Accessed September 15, 2013.
RECEIVED: 20 April 2014 REVISED: 10 June 2014 ACCEPTED: 20 June 2014
Copyright of Journal of Pain & Palliative Care Pharmacotherapy is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
REPORT
Evaluation of Clinical Pharmacy Services Offered for Palliative Care Patients in Qatar Kyle John Wilby, Alaa Adil Mohamad, and Sumaya AlSaadi AlYafei AB STRACT Palliative care is an emerging concept in the countries of the Gulf Cooperation Council, a political and economic union of Arab states bordering the Persian Gulf, namely Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates. Clinical pharmacy services have not yet been evaluated in this region. The objectives of this study were to create a baseline inventory of clinical pharmacy interventions in palliative care and to assess the perceived importance of interventions made. This was a prospective, single-center characterization study. Interventions were documented from September 30 to December 1, 2013. They were characterized into predetermined categories and analyzed using descriptive statistics. Physician acceptance rate and intervention rate per patient were calculated. Classification categories were sent to 10 practicing pharmacists in each of Qatar and Canada, who ranked the categories on the basis of perceived importance. A total of 96 interventions were documented, giving 3 interventions per patient and an acceptance rate of 81%. Discontinuing therapy (29%), initiating therapy (25%), and provision of education/counseling (13.5%) were most common. No differences were found between rankings from pharmacists in Qatar or Canada. Clinical pharmacy interventions are frequent, and those relating to alterations in drug therapy are most common. Interventions align with the perceived importance from pharmacists in both Qatar and Canada. KEYWORDS clinical pharmacy, hospice, palliative care, pharmacy, pharmacy education
pilot data on evaluating the benefit and effectiveness of services offered.4–8 However, no report was identified from a center in the Middle East or Gulf Cooperation Council (GCC). The GCC is a political and economic union of Arab states bordering the Persian Gulf, namely, Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates. The State of Qatar is rapidly becoming a regional and international leader for health care modernization and reform. A National Cancer Strategy was published that lists numerous objectives and key performance indicators to achieve from 2011 through 2016.9 Although ambitious, this strategy represents the best-known practices relevant to cancer care. Palliative care is a component of the strategy, and a multidisciplinary team was recently established at the National Center for Cancer Care & Research in Doha (NCCCR). A clinical pharmacist has been designated as a core component of this team. In 2013, an academic cross-appointment was established between the College of Pharmacy at Qatar
INTRODUCTION Palliative care is a complex health discipline that requires extensive collaboration and teamwork between health professionals, patients, caregivers, and administrative support.1 Patients have complex needs and a goal-oriented, team-based care plan is required for achievement of the best possible outcomes.2 As palliative patients typically have complicated medication regimens that require frequent adjustment and monitoring, a clinical pharmacist is a highly desirable team member.3 Reports have been published that describe the role of a pharmacist in palliative care and provide Kyle John Wilby, BSP, ACPR, PharmD, is an Assistant Professor and Alaa Adil Mohamad is a Pharmacy Student, College of Pharmacy, Qatar University, Doha, Qatar. Sumaya AlSaadi AlYafei, PharmD, is Assistant Director of Pharmacy, National Center for Cancer Care & Research, Doha, Qatar. Funding for this study was provided by a Qatar University Internal Student Grant. Address correspondence to: Dr. Kyle John Wilby, PO Box 2713, College of Pharmacy, Qatar University, Doha, Qatar (E-mail: [email protected]).
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University and NCCCR in palliative care. The College of Pharmacy has two clinical programs (Bachelor of Science in Pharmacy and Doctor of Pharmacy), both of which are accredited by the Canadian Council for Accreditation of Pharmacy Programs (CCAPP).10 The cross-appointment designates faculty members to establish and maintain a clinical practice, as well as formally precept students on 4-week internships. Typically, the cross-appointment is on site for clinical work 2 days per week. With larger numbers of pharmacy schools in the GCC seeking foreign accreditation, it is likely that the cross-appointment model in Qatar will be adapted elsewhere. This role is particularly unique due to the goal of modernizing health care through Canadian-accredited practice standards. Therefore, it is of great regional and international importance to describe and evaluate the types of recommendations and interventions occurring as part of the palliative care practice. The primary objective of this study was to create a baseline inventory of clinical pharmacy interventions after establishment of an academic cross-appointment in palliative care. Other objectives were to assess the perceived importance of these interventions.
METHODS Data were collected throughout the study period of September 30, 2013, to December 1, 2013. A data collection tool was developed, for which all data were recorded (see Appendix). Data obtained included number of patients admitted to palliative care while study pharmacists were on service, actual or potential drug therapy problem, clinical pharmacist intervention for resolution of identified drug therapy problem, and acceptance by the prescriber, if applicable. Similar methods were described previously.11 Intervention forms were copied and distributed independently to two investigators. Both investigators classified each recommendation according to an adaptation of a published classification method.12 Results were compared and any discrepancy was resolved through discussion and consensus. Classified recommendations were analyzed using descriptive statistics. Average numbers of recommendations per patient and recommendation acceptance rates were calculated. Education-related recommendations/interventions were not included in the acceptance rate, as the pharmacist does not need to seek permission to perform education-related activities. In order to assess perceived importance of each type of recommendation, an online survey was developed using online survey software (SurveyMon C
2014 Informa Healthcare USA, Inc.
213
key). The survey was sent to a convenience sample of 10 practicing pharmacists in Qatar and 10 practicing pharmacists in Canada. Canadian pharmacists were chosen as an international benchmark for clinical pharmacy. Additionally, the College of Pharmacy at Qatar University is accredited by the Canadian Council for Accreditation of Pharmacy Programs (CCAPP)10 ; therefore, Canadian input is warranted. Pharmacists were asked to rank each recommendation type on a 10-point scale. The 10-point scale consisted of numbers from 1 to 10, with 10 representing the highest importance and 1 representing the lowest importance. No site-specific information or results were given to the pharmacists in advance. Results from the survey were combined and each question was given a median score. For a secondary analysis, results were stratified for country of practice. The Mann-Whitney U test was used to determine if differences existed between overall rankings for each question between pharmacists in Canada and Qatar. Results were deemed significant if P < .05.
RESULTS A total of 96 recommendations were documented throughout the study time period (based on 24 working days of the pharmacist). The pharmacist saw 32 patients during this time, and this resulted in an average intervention rate of 3.0 interventions per patient. After removing education-based interventions, the prescriber acceptance rate was 81%. The results of the intervention classification are given in Table 1. Interventions regarding the discontinuation of drug therapy were most common (29%), followed by interventions regarding initiation of drug therapy (25%). Referring to other health care professionals was the least common intervention (2%), which is not surprising due to the nature of the inpatient practice. The most common medications involved with pharmacist
TABLE 1. Classification of Clinical Pharmacy Recommendations in Palliative Care Classified category of recommendations Discontinuation of therapy Initiation of therapy Education or counseling Dosage Increase Change in route of administration or dosage form Change in dose frequency or schedule Dosage decrease Laboratory monitoring Referral to other consult services
Number (%) 28 (29.2) 24 (25.0) 13 (13.5) 10 (10.4) 8 (8.3) 5 (5.2) 3 (3.1) 3 (3.1) 2 (2.1)
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JOURNAL OF PAIN & PALLIATIVE CARE PHARMACOTHERAPY
TABLE 2. Perceived Importance of Clinical Pharmacy Interventions in Palliative Care Recommendation category Initiation of drug therapy Discontinuation of drug therapy Adjusting doses Adjusting routes Patient education Diagnostic tests Nonpharmacological alternatives Adjusting schedules Physician/nurse education Laboratory monitoring Brand switches
Qatar Median Canada Median (range)a (range)a P value 10 (9–10) 10 (8–10)
10 (8–10) 10 (8–10)
.955 .758
10 (3–10) 8.5 (2–10) 10 (3–10) 9 (2–10) 9 (8–10)
8 (8–10) 10 (7–10) 10 (7–10) 7 (3–9) 9 (7–10)
.174 .397 1.000 .114 .918
8 (2–10) 10 (3–10)
8 (6–10) 10 (4–10)
.758 .918
9 (2–10) 6 (1–10)
7 (5–9) 8 (2–9)
.351 .837
a
Rankers were asked to rate each category of recommendations on a scale of 1 to 10, with 1 being not at all important and 10 being of highest importance.
interventions included metoclopramide, haloperidol, and fentanyl. All intervention types were ranked highly by pharmacists in both Qatar and Canada. The median and range for each question is given in Table 2. No significant differences existed between countries when rankings were compared, but the small sample size precluded detection of any meaningful differences. The most highly rated interventions were those regarding initiation and discontinuation of therapy, which matched the most commonly classified interventions in the unit.
DISCUSSION This study described an evaluation of clinical pharmacy services in palliative care in Qatar. To our knowledge, this is the first study to report on clinical pharmacy services in palliative care in the GCC and results are relevant to other countries in the region, as well as any country developing pharmacy services in palliative care. Additionally, the cross-appointment model described is useful for centers pursuing accreditation and attempting to integrate foreign performance standards into preexisting health care systems. The major finding of this study is the establishment of a baseline inventory of clinical pharmacy services in palliative care in Qatar. This inventory can be used as a benchmark to monitor and compare future initiatives, including expansion of pharmacy service and scope of practice. It also serves as an eval-
uation mechanism for the cross-appointment model in palliative care and may be used to justify the role of cross-appointments in other clinical areas. Finally, as palliative care teams become more common throughout the Middle East and abroad, the results of this study can be used as rationale for inclusion of a clinical pharmacist as an essential team member and can provide insight for the types of services they can offer. Although it is difficult to rank the perceived importance of interventions without being given patientspecific context, it was interesting that the categories of interventions most commonly documented by this study were ranked favorably by pharmacists in both Canada and Qatar. This is a significant finding, as practice should attempt to generally reflect which types of activities are deemed most useful. This is especially true for clinical pharmacy services, as pharmacists are largely able to tailor their practices according to which activities they prefer. For example, a pharmacist could focus solely on dosage and route of administration adjustments, instead of proactively suggesting changes in therapy. One surprising finding of this study was the de-emphasis of patient education documented as part of the clinical pharmacy services offered. However, this is likely explained by the fact the cross-appointed faculty member did not have Arabic language skills and the high majority of patients were native Arabic speakers. It can be speculated that patient education-related interventions would increased if the pharmacist could speak the primary language of the patients admitted to the service. Also, patient education occurred during the days the pharmacist was not present by covering pharmacy staff and this was not captured. Finally, due to the nature of palliative care, patient education activities may be less than those in other units. This study has limitations that should be addressed. First, it does not account for all services offered on this unit. Dispensary pharmacists may provide recommendations by identifying drug therapy problems from medication orders, or from direct contact with team members. Additionally, the crossappointed faculty member was on service 2 days per week and recommendations given by covering pharmacists were not documented. Secondly, the sample size of rankers was very low and precludes any meaningful comparisons between the countries. Future studies should attempt to have a larger number of rankers, as well as rankers from a variety of disciplines, including medicine, nursing, and palliative care patients. The major conclusions from this study are that clinical pharmacy services are being offered for palliative care patients in Qatar, with an emphasis on Journal of Pain & Palliative Care Pharmacotherapy
Report
initiating and discontinuing drug therapy; a crossappointed faculty member is effective at providing these services; and the services offered align with perceived importance from pharmacists in Qatar and Canada. Future studies should further assess the role of the pharmacist in palliative care, including team perceptions and measurable impacts on patient clinical outcomes. Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
REFERENCES [1] Hall P, Weaver L. Interdisciplinary education and teamwork: a long and winding road. Med Educ. 2001;35:867–875. [2] Hearn J, Higginson IJ. Do specialist palliative care teams improve outcomes for cancer patients? A systematic literature review. Palliat Med. 1998;12:317–332. [3] Strickland JM. An introduction to palliative pharmacy care. In Strickland JM, ed. Palliative Pharmacy Care, 1st ed. Bethesda, MD: American Society of Health-System Pharmacists; 2009:3–6. [4] Hussainy SY, Box M, Scholes S. Piloting the role of a pharmacist in a community palliative care multidisciplinary team: an Australian experience. BMC Palliat Care. 2011;10:16. [5] Ise Y, Morita T, Katayama S, et al. The activity of palliative care team pharmacists in designated cancer hospitals: a nationwide survey in Japan. J Pain Symptom Manage. 2014;47:588–593.
C
2014 Informa Healthcare USA, Inc.
215
[6] Norrstrom B, Cannerfelt I, Frid H, Roos K, Ramstrom H. Introduction of pharmaceutical expertise in a palliative care team in Sweden. Pharm World Sci. 2010;32:829–834. [7] Ryan N, Chambers C, Ralph C, England D, Cusano F. Evaluation of clinical pharmacists’ follow-up service in an oncology pain clinic. J Oncol Pharm Pract. 2013;19:151–158. [8] Wilson S, Wahler R, Brown J, Doloresco F, Monte SV. Impact of pharmacist intervention on clinical outcomes in the palliative care setting. Am J Hosp Palliat Care. 2011;28:316–320. [9] Supreme Council of Health. National Cancer Strategy 2011–2016. Available at: http://www.nhsq.info/strategy-goalsand-projects/national-cancer-strategy. Accessed April 10, 2014. [10] The Canadian Council for Accreditation of Pharmacy Programs (CCAPP). Accredited programs. Available at: http://www. ccapp-accredit.ca/accredited programs/. Accessed March 9, 2014. Accessed April 10, 2014. [11] Overhage JM, Lukes A. Practical, reliable, comprehensive method for characterizing pharmacists’ clinical activities. Am J Health Syst Pharm. 1999;56:2444–2450. [12] Pharmaceutical Society of Australia. Pharmacists performing clinical interventions. Document DRP and recommendation classification codes. Available at: http://www.psa.org.au/ supporting-practice/professional-practice-standards/clinicalinterventions. Accessed August 31, 2013. Accessed September 15, 2013.
RECEIVED: 20 April 2014 REVISED: 10 June 2014 ACCEPTED: 20 June 2014
Copyright of Journal of Pain & Palliative Care Pharmacotherapy is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
