Professor UConn School of Pharmacy Storrs, Connecticut, United States
Disclosure(s):
Marie A. Smith, PharmD: No financial relationships to disclose
Objectives: The objectives of this study were to: (1) describe the development of a primary care modeling tool – PCImpact – for pharmacists working on population health teams and pharmacists providing direct patient care on primary care teams, and (2) estimate the impact of integrated pharmacist services on PCP workload burden and opening PCP appointments to alleviate patient access problems. A pharmacist’s expertise in medication reconciliation, optimization, and management/ monitoring is complementary to the skills of primary care providers (PCPs). A challenge remains to identify the optimal use of pharmacists in primary care (PC) teams to offset PCP clinical workload burden and improve patient access to PCP appointments. For chronic medication management needs. Both clinical and administrative pharmacy leaders could benefit from pharmacist impact forecasts to justify implementing new or expanding current pharmacist services.
Methods: PCImpact is a forecasting tool that incorporates 2 types of primary care pharmacist practice models: population health (PH) and direct patient care (DPC). In the PH model, a centralized pharmacist performs one-time, comprehensive medication reviews using EHRs and has no direct patient interaction. PCPs review and implement any pharmacist recommendations. In the DPC model, an embedded PC pharmacist has written collaborative practice agreements (CPAs) with PCPs. CPAs allow the pharmacist to schedule patient appointments, assess medication regimens, implement medication changes, and order follow-up lab tests without requiring PCP followup to implement drug therapy plans -- thus, lowering PCP workload for chronic medication management. PCImpact was developed and tested with 6 primary care provider organization leaders within a federally qualified health center and health system-affiliated medical group by: (1) identifying pharmacist practice models, (2) obtaining site-specific data inputs through onsite workflow mapping, and (3) reviewing the PH and DPC scenario input data assumptions and estimated calculations with organizational leaders. For the PH and DPC pharmacist practice models, PCImpact calculates the: (1) pharmacist workload capacity as the number of unique patients receiving medication reviews or pharmacist-patient visits annually, (2) PCP time saved or required for implementation of the pharmacist recommendations and any additional PCP appointment opened, and (3) number of patients who benefit from pharmacist medication optimization/management recommendations.
Results: Pharmacists can conduct 2,304 one-time patient medication reviews in the PH model, whereas in the DPC model the pharmacist can only conduct 640 patient encounters since DPC initial and follow-up patient visits are longitudinal until the patients’ drug therapy problems are resolved. The PH practice model adds 384 hours to the PCP workload per year since the PCP needs to review and implement any of the pharmacist’s recommendations for any drug therapy changes or required monitoring tests. In the DPC model, there is a 640-hour PCP workload reduction since pharmacists use a collaborative practice agreement to implement any necessary drug therapy changes or order monitoring tests without requiring PCP review and approval. This leads to opening up 1,920 PCP appointments per year for more patients who have immediate care needs. The DPC model has more patients who benefit from pharmacist medication optimization/management recommendations (3,040 vs. 922) with the higher implementation rate of pharmacist recommendations (95% vs. 40%) with use of CPAs.
Conclusions: PCImpact is a novel tool to forecast the impact of different pharmacist practice models on PCP clinical workload and patient access to PCP visits. Pharmacy and medical leaders can justify initiating or expanding pharmacist services by forecasting the annual capacity of the pharmacist to perform medication reviews/patient visits and the resulting impact on PCP clinical workload and patient access to PCP appointments.
