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As authoritative resources on the optimal use of medications in symptom management, palliative care pharmacists exemplify several clinical, administrative, and educational roles within the outpatient clinic setting. Knowledge of medication-use processes allows pharmacists the ability to improve patient safety and outcomes. In 2018 a quality improvement project to optimize the scheduling of pharmacist-provider joint visits in the Dana-Farber Cancer Institute Outpatient Palliative Care Clinic led to overwhelming Adult Palliative Care (APC) provider satisfaction. Given this success and continued desire for pharmacy collaboration, the "PharmPAL" Clinic was initiated in July of 2020. PharmPAL is a collaborative drug therapy management (CDTM) clinic where credentialed pharmacists lead intermediary and follow-up palliative care visits encompassing patient assessments, counseling, education, ordering of laboratory tests, and selecting, initiating, continuing, and modifying medication regimens. The goal of PharmPAL is to support the growth of the palliative care clinic by providing care to patients with intense symptom management needs through interval visits with a pharmacist within their credentialed scope of practice, increasing the availability of follow-up to patients. Through a survey disseminated to all outpatient palliative care providers, reasons for referral for both joint visits and PharmPAL visits were gathered. Based on an overwhelming percentage of providers in favor of increasing PharmPAL visits, the weekly availability increased from eight 30 minute appointments per week in the first seven months to twelve 30 minute appointments each week. The top five reasons for PharmPAL referral include new consult requiring close follow-up, education and counseling, stable patient for refill review, schedule availability, and regimen or medication change in the previous visit or anticipated in visit. Barriers to utilizing PharmPAL include pharmacist availability, APC scheduling, and out-of-state patients. An increase in PharmPAL availability has led to an increased volume of patients and encounters for both PharmPAL and the outpatient clinic overall. Additional surveys will be employed to address feedback for ongoing areas for improvement in order to reach our goal of a 30% increase of PharmPAL referrals within the first three months and continued improvement in overall provider satisfaction with PharmPAL. As outpatient palliative care clinics are incorporating pharmacist-led visits into practice, identification of outcomes metrics is critical to the ongoing growth of these clinics. Over the next several months we plan to continue to assess the impact PharmPAL has on clinic operations and provider satisfaction in the Dana-Farber Cancer Institute outpatient palliative care clinic. [ABSTRACT FROM AUTHOR]

1. Outline an innovative model for integrating pharmacist-led patient care into a palliative care clinic. 2. Review two patient-centered outcomes that are improved by a pharmacist-led clinic and highlight clinical characteristics of patients who benefit from pharmacy involvement. Pharmacists play several roles within the outpatient palliative care setting, and their involvement in patient care is associated with improved patient safety and clinical outcomes. At Dana-Farber Cancer Institute, pharmacists have participated in co-visits with the primary palliative care clinician since 2001, and in July of 2020, a collaborative drug therapy management clinic, "PharmPAL," was piloted. PharmPAL clinic allows credentialed pharmacists to lead follow-up palliative care visits encompassing patient assessments, counseling, education, ordering of laboratory tests, and prescribing and managing medication regimens. The goal of PharmPAL is to increase access to palliative care by expanding the availability of follow-up care to patients with intense symptom management needs. Primary reasons for PharmPAL referral include new consult requiring close follow-up, education and counseling, stable patient for refill review, schedule availability, and patients with recent or anticipated medication changes. PharmPAL volume has grown from 24 visits in its first quarter of operation to 96 visits in the most recent quarter. We have increased pharmacist availability to support this growth and have plans for further expansion with a third pharmacist joining PharmPAL clinic in 2023. Surveys have confirmed clinician satisfaction with the various models of pharmacist support, and we continue to use feedback to plan pharmacist involvement within the palliative care clinic and PharmPAL. The increase of patient encounters in the pharmacist-led clinic has aligned with a concomitant increase in outpatient clinic volume overall. In this session we will share data around the implementation and growth of this model as well as lessons learned and practical tips around developing a similar model in your own setting. We will further describe two case examples of oncology patients managed in the PharmPAL clinic to demonstrate the comanagement between the pharmacists, oncologists, and palliative care clinicians as well as give examples of patient-related outcomes. [ABSTRACT FROM AUTHOR]

1. Review the roles of palliative care pharmacists in the outpatient clinic setting 2. Summarize current practice models in the outpatient palliative care setting 3. Outline the development of PharmPAL and overall clinic metrics Pharmacists play several roles in the outpatient palliative care setting, and their involvement in patient care is associated with improved patient safety and clinical outcomes. At Dana-Farber we have two primary ways that our embedded palliative care pharmacists are involved in clinical care. Pharmacists have participated in co-visits with the primary clinician since 2001, primarily providing suggestions about medication management. In July 2020 a collaborative drug therapy management clinic called PharmPAL was piloted. PharmPAL allows credentialed pharmacists to lead follow-up palliative care visits encompassing patient assessments, counseling, education, ordering of laboratory tests, and prescribing and management of medication regimens. The goal of PharmPAL is to support the palliative care clinic by increasing the availability of follow-up care to patients with intensive symptom management needs. We aimed to determine whether clinicians were satisfied with this pilot or whether it hindered interdisciplinary care by decreasing pharmacist availability for co-visits. Surveys were disseminated to assess clinician satisfaction with the various models of pharmacist support, and we used that feedback to plan future pharmacist support of the palliative care clinic. Primary reasons for PharmPAL referral included new consult requiring close follow-up, education, and counseling, stable patient for refill review, schedule availability, and patients with recent or anticipated medication changes. The main barriers to using PharmPAL involved pharmacist availability. Based on an overwhelming percentage of providers in favor of increasing PharmPAL visits, the weekly availability increased from eight 30-minute appointments per week to twelve 30-minute appointments each week. Increased PharmPAL availability led to a 38% increase in patient encounters in the PharmPAL clinic and an increase in outpatient clinic volume overall. Additional surveys are used to address feedback for ongoing areas for improvement to continue increasing PharmPAL referrals and maintain overall provider satisfaction with pharmacy involvement. [ABSTRACT FROM AUTHOR]