Development of a pharmacist telehealth service to enhance medication support for patients receiving community palliative care: a qualitative study

The provision of medication management reviews using telehealth is effective in identifying potential medication related problems. Palliative care pharmacists have the medication management skills to support doctors and other clinicians in managing palliative care patients’ medications. This study aimed to evaluate clinicians’ feedback on the feasibility of integrating a specialist palliative care pharmacist into an existing palliative care telehealth service. In-depth semi-structured interviews were conducted with purposively selected clinicians pre- and post-implementation of the palliative care pharmacist telehealth service at a public hospital and health service. Pre-implementation interviews were conducted before the pharmacist telehealth service commenced and informed the development of the palliative care pharmacist telehealth service model. Post-implementation interviews were conducted after the study intervention was concluded and reflected the clinician’s viewpoints on the feasibility of incorporating a pharmacist into the existing telepalliative care service. The pre-implementation interview tool consisted of 17 and the post-implementation tool of seven open-ended questions. Interviews were audio recorded, transcribed verbatim, and compared with field notes. Transcribed data were imported into NVivo 12 to facilitate coding and thematic analysis. In total 12 clinicians (doctors, nurses and allied health professionals) participated in the semi-structured interviews with eight participating in both the pre- and post-implementation interviews. Pre-interviews were conducted August-September 2020 with mean interview duration 25 min; post-implementation interviews were conducted May-June 2021 with mean interview duration 12 min. Pre-interview data revealed that most telehealth consultations involved discussions regarding medications, which took up a large portion of consultations, with main themes medication issues common to palliative care and pharmacists’ telehealth role. Key pharmacist roles were identified and incorporated into the new service model, delivered October 2020-March 2021. Post-implementation data highlighted clinician and patient benefits of integrating a specialist palliative care pharmacist into the existing palliative care telehealth service showing improved efficiency, increased clinician confidence, person-centred care and improved patient health literacy. Barriers, such as pharmacist availability and time, were identified but participants believed these could be managed and suggested improvements that could be made to overcome these. Integration of a specialist pharmacist into an existing palliative care telehealth service benefited patients and clinicians. These benefits included comprehensive medication reviews, prescribing support, patient education and provision of medication lists. Clinicians were supportive of this new model of care to continue. Integrating a dedicated pharmacist into the telepalliative care service meets the ongoing needs of both patients and clinicians and underscores the importance of multidisciplinary collaboration.