Comprehensive Medication Management Research Articles

Pharmacist telehealth in an underserved urban population with type 2 diabetes mellitus

BackgroundDuring the pre-vaccine months of the COVID-19 pandemic, pharmacists providing comprehensive medication management to underserved patients with type 2 diabetes mellitus at an urban Federally Qualified Healthcare Center shifted to telephone-based telehealth. ObjectivesThis retrospective, observational cohort study evaluated the effectiveness of clinical pharmacist telehealth while identifying associations between patient characteristics and efficacy measures. MethodsPatients with uncontrolled type 2 diabetes (hemoglobin A1c (HbA1c) ≥ 8%) with a clinical pharmacist visit between April 1 and August 31, 2020, were included. Telehealth effectiveness was measured by the proportions of: 1) patients reached, 2) appointments completed, and 3) the median change in HbA1c from baseline. Interventions by the clinical pharmacist were analyzed as a secondary outcome. ResultsThere were 181 patients scheduled and 172 (95%) of those patients kept at least one appointment. Of the 667 appointments scheduled, 73% were kept. Median HbA1c was reduced from 10.2% to 9.2% over 5 months of follow-up, and 24.6% of patients achieved a HbA1c < 8% (n = 138, p < 0.0001 for each). Greater HbA1c changes were associated with higher baseline blood glucose (p = 0.01), higher baseline HbA1c (p < 0.0001), non-insulin medications at baseline (p = 0.007) and among those with more kept visits (p = 0.03). The healthcare quality impact of interventions during each appointment was favorable; 83.3% brought care to a higher standard, 1.9% averted major organ dysfunction and 0.4% prevented death. ConclusionsClinical pharmacist telehealth was effective for providing patient-centered diabetes care when in-person office visits were not an option.

Reply to Comment on “Comprehensive medication management: Review and recommendations for quality measures”

Reply to Comment on “Comprehensive medication management: Review and recommendations for quality measures”

Comment on “Comprehensive medication management: Review and recommendations for quality measures”

Comment on “Comprehensive medication management: Review and recommendations for quality measures”

Critical care pharmacists have a rich history and evolving roles

AbstractCritical care (CC) pharmacists have been contributing to patient outcomes, team effectiveness, education, research and quality improvement for approximately 50 years. Current CC specialists are evolving the practice, science and scholarship into new and exciting areas as described in the series of articles collected for a special series in this journal. To summarize past accomplishments and contemplate how next level achievements may develop, brainstorming by experienced CC specialists, researchers, educators, and scholars was done to establish a foundation for this paper and three of that group summarized it into an overview of the challenges of the past and opportunities that are shaping the future. A small group of CC pharmacists identified need and opportunity to improve patient care in a limited number of settings but subsequent CC pharmacists have expanded into numerous specialties and subspecialties. Comprehensive medication management of CC patients and survivors of their critical illness is now a standard, but delivery may be influenced by new technology and equipment. Improved quality of care and outcome measures are being developed and measured. The imperative to move practice forward and adopt new practices while maintaining a core set of guideline‐based practices may be facilitated by technology such as wearable devices, personalized medicine, machine learning or artificial intelligence. However, these new tools may create new obstacles. Similar changes in education and expansion into administrative roles afford new opportunities and challenges. CC pharmacists have created a solid foundation, but continued growth in number and expansion of roles requires the next generation to continue to push ahead and continue to demonstrate value in key areas.

Atención farmacéutica en la bibliografía nacional e internacional

Healthcare Utilisation and Clinical Outcomes in Older Cardiovascular Patients Receiving Comprehensive Medication Management Services: A Nonrandomised Clinical Study Brajkovic A, Bosnar L, Int. J. Environ, Ramalho de Oliveira D, et al. Res. Public Health. 2022; 19(5): 2781. https://doi.org/10.3390/ijerph19052781 Are pharmacists’ knowledge and practice the key to promoting deprescribing of potentially inappropriate medication: a missing link between treatment and outcomes. Faris El-Dahiyat, Ammar Abdulrahman Jairoun, et al. International Journal of Pharmacy Practice, 2023; riad027 https://doi.org/10.1093/ijpp/riad027 A photovoice study on community pharmacists’ roles and lived experiences during the COVID-19 pandemic Kaitlyn E. Watson, Theresa J. Schindel, et al. Research in Social and Administrative Pharmacy. 2023; 19(6):944-955. https://doi.org/10.1016/j.sapharm.2023.03.005

Integrating comprehensive medication management in specialty clinics: A feasibility study

AbstractIntroductionPatients dealing with complex medical conditions requiring specialty care and polypharmacy therapy experience many challenges, including the lack of adequate medication optimization services. Pharmacists within specialty clinics are uniquely positioned to improve patient care by offering comprehensive medication management (CMM) services.ObjectivesThis study explores the feasibility of CMM delivery by clinical pharmacists within specialty clinics. More specifically, it aimed to (1) assess the pharmacists, pharmacy managers, and clinic team members' experience with CMM implementation; and (2) evaluate preliminary evidence of treatment effectiveness.MethodsSeven specialty clinics within an academic medical center were recruited to prepare for, implement, and evaluate CMM over an 18‐month period, with two additional clinics joining mid‐project. This exploratory feasibility study used mixed data to understand levels of service adoption, evaluate changes in feasibility indicators (acceptability, appropriateness, practicality, intent to continue use, and satisfaction), collect implementation feasibility insights, and evaluate treatment outcomes, both perceived and based on medication therapy problem (MTP) resolution rates. Data sources included administrative data, surveys, interviews, and MTP documentation.ResultsService uptake was highly context dependent, with three of the five clinics discontinuing participation doing so because of challenges with service fit (appropriateness). For the four clinics implementing CMM throughout the study, the benefits were evidenced by the positive changes in the feasibility indicators ratings, perceived improved patient care, and a 96.2% MTP resolution rate. Gaining an understanding of CMM as a service and its potential role within a specialty clinic, ensuring buy‐in from clinics and management, identifying implementation strategies such as preparation of workflows, and using a standardized MTP documentation form were highlighted as critical to successful implementation.ConclusionProviding CMM as a service option for complex patients in specialty care clinics was deemed feasible and beneficial, providing alignment with the clinic culture, patient care approach, and pharmacist role.

Defining the value of faculty primary care clinical pharmacists

Demonstrating the value of comprehensive medication management (CMM) within clinical faculty sites is a challenge when balancing patient volume with academic responsibilities. Utilizing an evidence-based implementation system for CMM, faculty primary care clinical pharmacists (PCCPs) standardized CMM within their practice sites. The primary objective of this project was to define the value of faculty PCCPs. An Ambulatory Care Summit was hosted to identify opportunities for consistency of CMM. Following the summit, the CMM implementation team (faculty PCCPs and project manager) utilized CMM implementation tools from the Comprehensive Medication Management in Primary Care Research Team. Additionally, a strategic plan was developed to enhance practice management, improve fidelity, and determine key performance indicators (KPIs). Five faculty-mentored student projects assessed value of faculty-delivered CMM in primary care clinics. Data included medication adherence metrics, clinic quality metrics, diabetes metrics, acute healthcare utilization rates, and a physician satisfaction survey. Among those receiving CMM, adherence improved 14% (P=0.022), 119 clinic quality metrics were achieved, HbA1c≤9% improved 45% (p<0.001), average HbA1c decreased by 1.73% (p<0.001), and medication preventable acute care utilization within the referral reason decreased. Over 90% of physicians surveyed agreed the faculty PCCP is a valuable team member, improved patients' health, and improved effectiveness/efficiency. Four student posters were presented at national conferences and 18 student pharmacists were engaged in various aspects of the project. Incorporating CMM at faculty primary care clinics provides value. To demonstrate this value, faculty must align KPIs with institution-specific payer contracts.

Optimizing Multidisciplinary Care of Patients with Chronic Kidney Disease and Type 2 Diabetes Mellitus.

Diabetes is the leading cause of chronic kidney disease (CKD), a condition associated with significant morbidity and mortality. As these patients have a high risk of developing cardiovascular disease and end-stage kidney disease, there is a need for early detection and early initiation of appropriate therapeutic interventions that slow disease progression and prevent adverse outcomes. Due to the complex nature of diabetes and CKD management, a holistic, patient-centered, collaborative care approach delivered by a coordinated multidisciplinary team (ideally including a clinical pharmacist as part of a comprehensive medication management program) is needed. In this review, we discuss the barriers to effective care, the current multidisciplinary approach used for CKD prevention and treatment, and the potential ways that the multidisciplinary management of CKD associated with type 2 diabetes mellitus can be refined to improve patient outcomes.

An International, Multicenter Evaluation of Comprehensive Medication Management by Pharmacists in ICU Recovery Centers.

Post-intensive care syndrome (PICS) is defined as a new or worsening impairment in physical, cognitive, or mental health following critical illness. Intensive care unit recovery centers (ICU-RC) are one means to treat patients who have PICS. The purpose of this study is to describe the role of pharmacists in ICU-RCs. What is the number and type of medication interventions made by a pharmacist at an ICU-RC at 12 different centers? This prospective, observational study was conducted in 12 intensive care units (ICUs)/ICU-RCs between September 2019 and July 2021. A full medication review was conducted by a pharmacist on patients seen at the ICU-RC. 507 patients were referred to the ICU-RC. Of these patients, 474 attended the ICU-RC and 472 had a full medication review performed by a pharmacist. Baseline demographic and hospital course data were obtained from the electronic health record and at the ICU-RC appointment. Pharmacy interventions were made in 397 (84%) patients. The median number of pharmacy interventions per patient was 2 (interquartile range [IQR] = 1,3). Medications were stopped and started in 124 (26%) and 91 (19%) patients, respectively. The number of patients that had a dose decreased and a dose increased was 51 (11%) and 43 (9%), respectively. There was no difference in the median total number of medications that the patient was prescribed at the start and end of the patient visit (10, IQR = 5, 15). Adverse drug event (ADE) preventive measures were implemented in 115 (24%) patients. ADE events were identified in 69 (15%) patients. Medication interactions were identified in 30 (6%) patients. A pharmacist plays an integral role in an ICU-RC resulting in the identification, prevention, and treatment of medication-related problems. This paper should serve as a call to action on the importance of the inclusion of a pharmacist in ICU-RC clinics.

DEA-registered clinical pharmacist practitioners: Progressing practice to increase patient care access.

This descriptive review aims to describe the impact of controlled substance prescriptive authority (CSPA) among Drug Enforcement Administration (DEA)-registered clinical pharmacist practitioners (pharmacists) within the Veterans Health Administration (VA). The practice perspectives of pharmacists with CSPA are also reviewed. A 3-part methodology included identification and query of DEA-registered pharmacists, practice impact data analysis, and time and motion prescribing analysis. Between quarter 1 of fiscal year 2018 and quarter 2 of fiscal year 2022, the number of DEA-registered pharmacists in the VA grew by 314%, from 21 to 87 pharmacists. Pharmacists in pain management and mental health reported benefits of CSPA, with the most common being practice autonomy (93%), increased efficiency (92%), and reduced burden on other prescribers (89%). Initial challenges to pharmacists obtaining DEA registration included a lack of incentive (46%) and concern about increased liability (37%). A time and motion analysis demonstrated that pharmacists with CSPA saved a median of 12 minutes for prescription writing compared to those without CSPA. There is an opportunity for DEA-registered pharmacists to meet patient care needs to fill gaps in care from physician shortages, improve health equity, and provide quality healthcare for vulnerable, underserved populations, especially in areas where controlled substance prescribing is common. To fully optimize the role of the pharmacist, it is imperative that state practice acts be expanded to include pharmacist DEA authority as part of collaborative practice and that fair and equitable payment models be established for pharmacist comprehensive medication management.

Implementation of an integrated ambulatory care pharmacist collaborative care workflow model in specialty clinics in a large academic health system.

Ambulatory care and specialty pharmacy practices are rapidly growing in tandem with the accelerated development of advanced therapies for complex disease states. A coordinated and standardized interprofessional team-based approach is critical to providing high-quality care to specialty patients on complex, expensive, and high-risk therapies. Yale New Haven Health System dedicated resources to the creation of a medication management clinic under a unique care model that integrates ambulatory care pharmacists within specialty clinics who coordinate with centralized specialty pharmacists. The new care model workflow encompasses ambulatory care pharmacists, specialty pharmacists, ambulatory care pharmacy technicians, specialty pharmacy liaisons, clinicians, and clinic support staff. The strategies employed to design, implement, and optimize this workflow to meet the increasing demand for pharmacy support in specialty care is discussed. The workflow incorporated key activities from highly diverse existing specialty pharmacy, ambulatory care pharmacy, and specialty clinic practices. Standard processes were developed for patient identification, referral placement, visit scheduling, encounter documentation, medication fulfillment, and clinical follow-up. Resources were created or optimized to support successful implementation, including an electronic pharmacy referral, specialty collaborative practice agreements to facilitate pharmacist-led comprehensive medication management, and a standardized note template. Communication strategies were developed to facilitate feedback and process updates. Enhancements focused on eliminating documentation redundancies and delegating nonclinical tasks to a dedicated ambulatory care pharmacy technician. The workflow was implemented in 5 ambulatory rheumatology, digestive health, and infectious diseases clinics. Pharmacists utilized this workflow to complete 1,237 patient visits, serving 550 individual patients over 11 months. This initiative created a standard workflow to support an interdisciplinary standard of specialty patient care that is robust to accommodate planned expansion. This workflow implementation approach can serve as a road map for other healthcare systems with integrated specialty and ambulatory pharmacy departments undertaking similar models for specialty patient management.

장기요양시설 노인의 포괄적 약물관리 프로그램 운영현황

Polypharmacy and potentially inappropriate medication use have increased among the residents of long-term care facilities (LTCF). Nevertheless, Comprehensive Medication Management (CMM) for LTCF residents was not implemented in Korea. The United Kingdom, Canada, the United States, and Australia have already introduced CMM for managing drug-related problems in LTCF. This study discussed the implications of developing the CMM service for LTCF residents in Korea by reviewing the system of these countries. The contents and requirements of CMM are investigated through relevant papers and official reports of the public institution of each country. The CMM service of these countries is regularly conducted based on their system and laws. In Canada, there are no additional requirements such as special education and qualifications for pharmacists providing CMM. But in other countries, it is preferred that pharmacists providing CMM are geriatric pharmacists or take the education that is equivalent to them. In addition, all these countries utilize national computer networks or electronic healthcare records that are used for executing CMM and for sharing with other medical experts, and then they are retained as official medical records. It is necessary to consider the system of other countries when introducing the CMM service for LTCF residents in Korea.

Clinical impact of comprehensive medication management services offered to geriatric and hypertensive patients

Abstract Objectives To assess the clinical impact of comprehensive medication management (CMM) services offered to geriatric and hypertensive patients in primary health care in Brazil. Methods A quasi-experimental study was carried out with patients followed up in primary care in three Brazilian cities (n = 346). McNemar’s test was used to assess the clinical impact of the service. Key findings A total of 1308 drug therapy problem (DTPs) were identified and 581 (44.4%) were resolved. Among the DTPs, the majority were related to non-adherence to therapy (23.9%; n = 313) or the need for additional medications (18.2%; n = 238). It was observed an increase in the proportion of people who had their blood pressure controlled at the last visit when compared with the first visit. Conclusions This study indicates that the CMM service can contribute to achieving blood pressure control in geriatric and hypertensive patients. The frequency of DTPs was high in the studied population, but many DTPs were resolved by pharmacists.

A descriptive analysis of primary care providers' interest in clinical pharmacy services

BackgroundVarious clinical pharmacy services exist to improve the health outcomes of patients. However, there are numerous barriers to their implementation and execution, especially in outpatient settings. As pharmacists design and implement clinical pharmacy services in outpatient settings, they often do not consider the needs of providers until after service development. ObjectivesThe purpose of this study was to assess primary care providers' (PCPs') perceptions of clinical pharmacy services and their clinical pharmacy support needs. MethodsA web-based survey was distributed via email to PCPs across North Carolina (NC). Survey dissemination was completed in two phases. Data analysis consisted of mixed methods – quantitative and qualitative. Descriptive statistics were used to analyze demographic differences within each phase as well as the ranking of medication classes/disease states by providers. Qualitative data analysis through inductive coding was done to assess provider perceptions of clinical pharmacy services. ResultsThe response rate of the survey was 19.7%. Providers with previous experience with a clinical pharmacist rated overall services as positive. 62.9% of PCPs (N = 80) provided their perception of the positive attributes (pros) of clinical pharmacy services. 53.5% of PCPs (N = 68) provided their perception of the negative attributes (cons) of clinical pharmacy services. The top three medication classes/disease states that providers indicated they would value clinical pharmacy services for were: comprehensive medication management (CMM), diabetes medication management, and anticoagulation medication management. Of the remaining areas assessed, statin and steroid management ranked the lowest. ConclusionsThe results from this study demonstrated that clinical pharmacy services are valued by PCPs. They also highlighted how pharmacists can best contribute to collaborative care in outpatient settings. As pharmacists, we should aim to implement the clinical pharmacy services that PCPs would value most.

Flip the Pharmacy’s impact on comprehensive medication management performance

BackgroundClinically integrated networks of community pharmacies are expanding partnerships with health care payers for sustainable provision of patient care services. The Pennsylvania Pharmacists Care Network (PPCN), a part of CPESN USA, launched its first payer program in 2017 with a Medicaid managed care organization for comprehensive medication management (CMM). Some PPCN pharmacy teams have participated in Flip the Pharmacy, a national practice transformation initiative. ObjectivesThis study aimed to determine whether pharmacy participation in Flip the Pharmacy was associated with a greater rate of CMM encounters than in nonparticipating pharmacies within a statewide clinically integrated network. MethodsThis project was a retrospective quantitative study. CMM encounter data including total number of encounters and total number of eligible members were extracted from monthly reports. Generalized estimating equations were used to assess the association between Flip the Pharmacy participation and CMM encounter rates. ResultsOf 103 pharmacies that participated in the CMM program in 2019 and 2020, 77.7% of pharmacies (n = 80) were included in analyses. Of these, 31.3% (n = 25) participated in Flip the Pharmacy. Overall, 80 pharmacies documented 8460 patient encounters through the CMM program. On average, pharmacies participating in Flip the Pharmacy recorded 1.67 times the rate of encounters compared with non-Flip the Pharmacy pharmacies (95% CI 1.10–2.54), controlling for single versus multiple pharmacy sites and weekend hours. On average, pharmacies participating in Flip the Pharmacy recorded 1.18 times the rate of initial encounters (95% CI 0.84–1.59) and 2.06 times the rate of follow-up encounters (95% CI 1.22–3.48) compared with non-Flip the Pharmacy pharmacies. ConclusionParticipation in Flip the Pharmacy in Pennsylvania was associated with greater engagement and completion of encounters within a payer program for CMM. Continued practice transformation efforts are needed to ensure the sustainability of community pharmacy practice as it continues to expand into payment for patient care services.

Professionals' and Patients' Perspectives on Criteria for Referring Hypertensive Patients to Comprehensive Medication Management Services in Public Primary Health Care.

Patient prioritization in comprehensive medication management services allows coordinating care and guiding patients according to their clinical profile and their medication use. The aim of the study is to identify and describe factors that indicate the need for comprehensive medication management services among primary care hypertension patients within a public health system from the perspective of patients, pharmacists, nurses and physicians. A qualitative study was carried out with interviews with nurses, pharmacists and physicians (n = 20), and two focus groups with hypertensive patients (n = 12) at primary health care facilities and a public outdoor fitness area between January and February 2019 in Brazil. All interviews were transcribed and analyzed using the Atlas.ti® software. The data analysis revealed the following factors indicative of the need to refer hypertension patients to a pharmacist: lifestyle habits, comorbidities, health care utilization and medication use. The issues identified and the information obtained from the qualitative research and compared with literature studies reviewed allowed defining dimensions that should be considered as an aid in the selection of uncontrolled hypertensive patients for comprehensive medication management services.

What types of information do pharmacists include in comprehensive medication management review reports? A qualitative content analysis

BackgroundComprehensive medication management reviews are an established intervention to identify medication-related problems, such as the prescribing of potentially inappropriate medications, and under- and over-prescribing. However, the types of information included in written reports of comprehensive medication management reviews, beyond types of medication-related problems, are unknown.AimThis study aimed to explore the types of information Australian pharmacists include in their written reports following comprehensive medication management reviews.MethodAustralian consultant pharmacists were invited to upload their 10 most recent written reports of their domiciliary-based comprehensive medication management reviews. A random selection of the reports, stratified by each pharmacist, were included for qualitative content analysis.ResultsSeventy-two de-identified reports from eight consultant pharmacists located in five of the eight Australian States and Territories were included for analysis. From the evaluated reports, four major categories of information were identified: (1) patient details such as date of interview (n = 72, 100%) and medicine history (n = 70, 97%); (2) pharmacist assessment including assessment of the patient (n = 70, 97%), medicines management (n = 68, 94%) and medicine-related issues (n = 60, 83%); (3) pharmacist recommendations, specifically pharmacological recommendations (n = 67, 93%); and (4) patient-centred experiences such as perspectives on medicines (n = 56, 78%). Reporting of patient-centred experiences appeared most variably in the included reports, including patient concerns (n = 38, 53%), willingness for change (n = 27, 38%), patient preferences (n = 13, 18%), and patient goals (n = 7, 10%).ConclusionPharmacists within our study included a wide variety of information in their comprehensive medication management review reports. Aside from medication-related problems, pharmacists commonly provided a holistic assessment of the patients they care for. However, variability across reports has the potential to impact consistent service delivery.

Pharmacist‐delivered comprehensive medication management in a substance use disorder clinic, an 18‐month descriptive study

AbstractIntroductionPharmacists have expanded their roles within interprofessional teams in substance use disorder (SUD) care, but data characterizing pharmacist‐delivered comprehensive medication management (CMM) in outpatient SUD treatment are limited.ObjectivesThe purpose of this study was to characterize the patient population, and medication therapy problems (MTPs), and describe considerations for CMM development and implementation in an outpatient SUD treatment setting.MethodsAn observational, prospective, descriptive study was conducted in an outpatient SUD center. A clinical pharmacist provided CMM services to referred clients and documented data elements after each visit. The pharmacist comprehensively assessed clients' complete regimens to optimize medication use through collaboration with the clients and other healthcare providers. A post‐CMM electronic survey was sent to the clients' care teams to assess their attitudes and collect feedback regarding the collaboration process. Descriptive statistics were employed to describe the population, CMM services, MTPs, and survey responses.ResultsFrom April 1, 2021, to September 30, 2022, a total of 187 CMM encounters were delivered to a total of 112 clients with SUD. Nearly all patients (99%) had opioid use disorder as their primary diagnosis and the vast majority (95%) were receiving methadone treatment. Clients’ mean age was 39‐years‐old with an average of eight medications and six medical conditions. Of 201 MTPs identified, 54 MTPs (27%) were marked as “resolved” at follow‐up visits. The most commonly identified MTP category was the need for additional drug therapy (31%). The care team survey showed 100% agreed or strongly agreed that the CMM consult was helpful to the clients and the care team members.ConclusionPharmacist‐delivered CMM in a SUD treatment setting was feasible and well perceived by care team members as helpful to bridge existing gaps in access to biomedical care, medication optimization, and medication use care coordination.

Social Determinants of Health in People Living with Psychiatric Disorders: The Role of Pharmacists.

Social determinants of health (SDOH) affect outcomes of people living with psychiatric disorders, including substance use disorders. As experts in medication optimization, pharmacists play a vital role in identifying and addressing medication-related problems associated with SDOH. However, there is a paucity of literature on how pharmacists can be part of the solution. The purpose of this article is to provide a narrative review and commentary on the intersection between SDOH, medication-related outcomes in people living with psychiatric disorders, and the role of pharmacists in addressing them. The American Association of Psychiatric Pharmacists appointed an expert panel to research the issue, identify barriers, and develop a framework for including pharmacists in addressing medication therapy problems associated with SDOH in people with psychiatric disorders. The panel used Healthy People 2030 as the framework and sought input from public health officials to propose solutions for their commentary. We identified potential connections between SDOH and their impact on medication use in people with psychiatric disorders. We provide examples of how comprehensive medication management can afford opportunities for pharmacists to mitigate medication-related problems associated with SDOH. Public health officials should be aware of the vital role that pharmacists play in addressing medication therapy problems associated with SDOH to improve health outcomes and to incorporate them in health promotion programs.

Provider survey of the roles of clinical pharmacists in primary care in a Federally Qualified Health Center versus an Accountable Care Organization

BackgroundHealthcare providers at primary care Federally Qualified Healthcare Centers (FQHC) and an Accountable Care Organizations (ACO) collaborated with clinical pharmacists in providing patient care utilizing the comprehensive medication management (CMM) framework. The intention of CMM was to generate more time for providers to see patients, and to improve overall patient quality of life. ObjectivesThe purpose of this study was to survey the providers' views of clinical pharmacy services, and to compare and contrast the shared-visit model in rural FQHCs and an ACO collaborative practice agreement model in a mid-sized metropolitan area. MethodsPrimary care providers completed a five-domain 22-item survey of provider patient care, provider pharmacy consults, provider ranking of pharmacy-services, disease treatment and provider views on the value of clinical pharmacists. ResultsFQHC pharmacists were available one day per week (75%), while 69% of ACO pharmacists were available five days per week. FQHC providers requested <5 pharmacist consults per week (46%), while ACO requested >10 consults per week (44%). Both organizations had nearly identical provider rankings and impact on patient care for clinical pharmacy services and disease-focused pharmacy services. The provider survey of satisfaction with pharmacy consultations were highly positive and scored as strongly agree with FQHC and ACO, with the exception of three items with the FQHC. Overall providers at both organizations report highly effective medication-related improvements, disease outcomes and also recommend clinical pharmacists to other providers and primary care teams. Regression analysis revealed relevant clinical associations between survey statements not seen with individual survey items alone. ConclusionPrimary care providers report high satisfaction with, and benefits of, clinical pharmacy services. Drug information resource and disease-focused management were documented by providers as valuable pharmacy services. Providers promoted expanding the role of clinical pharmacists with providers, and integration into primary care teams.