Impact of Palliative Care Clinical Pharmacists in an Inpatient Care Setting on Total Health Care Expenditures.

Abstract

<b><i>Background:</i></b> Inpatient palliative care clinical pharmacy specialists (IPCPS) on multidisciplinary palliative care (PC) teams have expanding roles in the treatment of pain, nausea, and other symptoms for patients with serious illnesses. <b><i>Objectives:</i></b> The aim of this study was to assess the clinical and financial outcomes associated with an IPCPS on an inpatient PC team. <b><i>Setting and Design:</i></b> This was a retrospective cohort study conducted in Colorado. Adult patients with an inpatient stay and a PC consult between October 1, 2016 and February 28, 2019 were included. Patients were assigned to the observation group if they received PC from a clinical pharmacist and control group if they received usual PC. The primary outcome was the 180-day change in daily total cost-of-care expenditures. Secondary outcomes included length of index hospitalization and 180-day change in daily morphine milligram equivalents (MME), health care utilization, and opioid adverse effects (AE). <b><i>Results:</i></b> A total of 1543 patients were included with 228 and 1315 in the IPCPS and usual care groups, respectively. After adjustment, the IPCPS group had a greater median decrease in daily expenditures (-$22 vs. $6, <i>p</i> = 0.003), higher median increase in daily MME (16.5 vs. 9.7 mg, <i>p</i> = 0.007), and fewer patients with a subsequent hospitalization (34.2% vs. 39.2%, <i>p</i> = 0.010) or urgent care visit (10.5% vs. 14.6%, <i>p</i> = 0.024) but longer mean index hospitalization (9.3 vs. 7.7 days, <i>p</i> = 0.003) and no differences in AE during follow-up (all <i>p</i> > 0.05). <b><i>Conclusion:</i></b> IPCPS participation on the PC team can be a component of health care cost reduction while contributing to patient-centered quality care.