Pilot Study on the Role of Board Certified Pharmacists in Palliative Pharmacy to Enhance Pharmacist Participation in Pre-Discharge Conferences for Home-Based Palliative Care in Japan.

内容摘要

Ensuring a smooth transition from hospital cancer care to home palliative care remains a key challenge, while pharmacist involvement in pre-discharge conferences has traditionally been limited in Japan. We investigated whether coordination by the Board Certified Pharmacist in Palliative Pharmacy (BCPPP) could enhance the extent and quality of pharmacist participation. In this retrospective descriptive observational study, we examined pre-discharge conferences for patients with advanced cancer, pharmacist participation rates and level of involvement from hospital and community pharmacies, methods of medical narcotics administration, and the rates of short-term readmission from January 2018 to December 2024. The BCPPP-led coordination initiative was initiated in 2022, which comprises of identification of the patients requiring home palliative care, arranging the pre-discharge conferences, support for opioid pharmacotherapy, coaching ward pharmacists, and ensuring the continuity of pharmacotherapy after discharge. Outcomes were compared between periods before (2018-2021) and after the start of interventions by a certified pharmacist (2022-2024). A total of 110 pre-discharge conferences were conducted. The certified pharmacist in palliative pharmacy coordinated collaboration with medical social workers. Pharmacist participation in pre-discharge conferences significantly increased after the intervention (hospital: 9.3% vs. 80.0% [p < 0.01], community pharmacies: 5.3% vs. 54.3% [p < 0.01]). The proportion of pharmacist recommendations focused on discharge planning increased from 35.7% to 73.3% (p < 0.05). The two- and four-week readmission rates did not differ significantly before and after the intervention (two-week: 13.2% vs. 3.0%; four-week: 17.6% vs. 18.2%). Coordination by a certified pharmacist in palliative pharmacy increased pharmacist participation inside and outside the hospital and promoted more proactive involvement in palliative care during pre-discharge planning. Although short-term readmission rates did not significantly change, strengthened collaboration between hospital and community pharmacies may contribute to improved continuity of palliative care during the transition to home.