Purpose: The purpose of this project is to describe the impact of an oncology clinical pharmacist provider and document the utility and benefit to patient care. The evolution of collaborative practice agreements has expanded the scope of services pharmacists are able to provide. The VA pioneered one of the earliest examples of this level of practice through the establishment of clinical pharmacy specialists with the authority to prescribe medications and order labs, etc. The positive impact of pharmacist intervention on patient outcomes has been well documented for several chronic disease states, as well as associated cost savings.
Methods: The pharmacist provider operated by a “scope of practice,” which is the VA collaborative practice agreement with a physician, in this situation a medical oncologist. In this series, 1 year of data is reviewed (January 1 to December 31, 2013). Notes in CPRS were reviewed retrospectively for specific data. Visits included were all appointments scheduled into the outpatient Oncology Clinical Pharmacist clinic. The times of the Oncology Clinical Pharmacist clinic were Monday through Thursday 8:30 am-12:00pm. In April 2014, the IRB determined this effort was not research. The goal of the pharmacist provider was to optimize the outcomes of drug therapies and ensure safe drug therapy in accordance with available literature.
Results: A total of 1,426 individual appointments were completed. Appointments were 15, 30, or 45 minutes in length. The total time with visits was 41,185 minutes (686.4 hours). Demographics and disease states available for expanded presentation. The following interventions were documented during this time period in table. Pharmacy students or residents were involved with patient care for 185 visits, which is 13% of visits for 2013. With each visit, pharmacist performed a review of systems, review of available labs and other exams and in some cases limited physical assessment. Additionally, consults were placed (with oncologist approval) as appropriate to palliative care, social services, radiation oncology, and other medical subspecialties as applicable.
Conclusions: These data document a substantial impact on patient care in volume and scope of services provided by an oncology pharmacist provider. The key is a close collaborative practice with an oncologist, and knowing when to get oncologist involved in patient-specific issues. With this backbone, the pharmacist can be an integral and productive member of the oncology care team as a pharmacist provider.
