PCImpact: A modeling tool for forecasting impact of primary care pharmacist services.

Abstract

The role of the pharmacist in primary care (PC) has expanded to focus on medication optimization and management for chronic conditions. However, identifying the optimal pharmacist practice model to maximize pharmacist workload capacity, patient care quality, and PC provider satisfaction remains a challenge. PC clinical and administrative leaders could benefit from pharmacist impact forecasts to justify initiating new or optimizing/expanding current pharmacist services. (1) To describe the development of a PC pharmacist services modeling tool, PCImpact (2) To discuss the use of PCImpact by PC leaders to initiate, optimize, or expand integrated pharmacist services. PCImpact was developed and internally tested with 6 clinical/administrative leaders within a federally qualified health center and health system-affiliated primary care organization by: (1) identifying pharmacist practice models, (2) obtaining data input values for PCImpact, and (3) calculating PCImpact output values. Two types of pharmacist practice models are defined: population health (PH) and direct patient care (DPC). In the PH models, a centralized pharmacist performs one-time, comprehensive or targeted medication reviews with no direct patient interaction. PC providers review and implement pharmacist recommendations. In DPC models, an embedded pharmacist in a PC practice performs patient visits with or without collaborative practice agreements with PC providers. Default values for all PCImpact data inputs were obtained/tested through literature reviews and discussions with pharmacy and physician leaders, including pharmacist and PC provider time required, and implementation percentage of pharmacist recommendations. PCImpact calculates: (1) pharmacist workload capacity, (2) PC provider time impact, and (3) patient care impact. PCImpact presents a novel method to objectively forecast the impact of PH and DPC pharmacist services in 2PC settings. PCImpact outputs showed that a DPC pharmacist practice model can save PC provider time and impact a greater number of patients compared to a PH pharmacist practice model.