Expansion Of Clinical Pharmacy Services Research Articles

Diversification and Expansion of Clinical Pharmacy Services: Is it Time for Senior Care Pharmacists to Step Into the Light?

According to the American Board of Medical Specialties, there were 7,123 certified geriatricians practicing in the United States in 2021. The Health Resources and Services Administration estimates a shortage of 27,000 geriatricians in 2025. Only 43% of geriatrics fellowship spots were filled in 2022. With this forthcoming decrease in medical providers, the role of the senior care pharmacist must expand and diversify to provide an equitable level of care that older patients will need-especially with the expansion of antipsychotic, antimicrobial, and opioid stewardship programs. Senior care pharmacists possess a diverse range of skills and knowledge that are indispensable to the health care team. It is time to move beyond the consultant role, expanding both clinically and operationally, to provide the quality health care that older patients need.

Expansion of around the clock critical care and emergency medicine clinical pharmacy services at a large urban academic medical center

AbstractThe impact of a pharmacist as a dedicated member of multidisciplinary intensive care unit (ICU) and emergency department (ED) teams has repeatedly been described in the literature for over 20 years. A 2020 position paper published by the Society of Critical Care Medicine and the American College of Clinical Pharmacy recommended the optimal practice model include critical care pharmacists providing direct patient care 24 h a day, 7 days a week. The objective of this paper is to describe the expansion and evolution of clinical pharmacy services provided in the ICU and ED at a large academic health center, beginning in 2015 and accelerated in the face of a global pandemic. This was made possible through a combination of creating new positions and reallocating existing positions to substantially increase ICU and ED clinical pharmacy coverage. Over a 7 year period, the emergency medicine and critical care clinical pharmacy team expanded from six full time equivalent (FTE) employees in 2015 to 16 FTEs in early 2022. This allowed for reduced pharmacist to patient ratios, the expansion of clinical pharmacy services from primarily weekday hours to a 24 h per day coverage model, 7 days a week, and to better support clinical pharmacy specialists providing these services. Rapid expansion of around the clock clinical pharmacy services was only possible through collaboration between clinical and operations pharmacy managers and feedback from members of the multidisciplinary team.

Pharmacist Expansion to Tele-Health Visits in Heart Transplant Clinic

PurposeDuring the COVID-19 pandemic, inpatient cardiothoracic transplant pharmacists expanded clinical services to include remote telehealth visits to increase patient access to pharmacy services and streamline visits for providers. Pharmacist visit activities included adherence and medication access assessments, adverse effect assessment and management, chart reviews, and medication reconciliation.MethodsA single center retrospective chart review of 80 heart transplant recipients transplanted between January 2020 and December 2020 was completed. From July 2020 - March 2021, pharmacists called patients within the first year of transplant prior to scheduled provider clinic visits. Patients were not called if they had been called within the prior 4 weeks. Activities from clinic visits before and after pharmacist involvement were compared at 1 month, 3 months, 6 months, and 12 months post-transplant. The goal of this analysis was to describe the number and types of interventions made by the pharmacist.ResultsA total of 100 patients and 272 clinic visits were analyzed, baseline clinical characteristics did not differ in the two cohorts. Pharmacists performed 233 tele-health visits which resulted in 394 interventions from July 2020 - March 2021, summarized in Figure 1. The most common interventions included adverse effect management (34%) and renal dose adjustment (17.8%). An analysis of outpatient visits before and after pharmacist involvement found no significant difference in reported adherence, appropriate renal dosing of medications or reported neurotoxicity (Table 1).ConclusionClose to 400 interventions were made by our transplant pharmacy team through tele-health visits over a period of 8 months. Use of pre-visit pharmacist tele-health assessments allowed for expansion of clinical pharmacy services while facilitating more focused provider clinic visits. more consistency in clinic may yield improved post-pharmacist outcomes, though further analysis is warranted.

Considerations and approaches to expansion of solid organ transplant pharmacist services

AbstractSolid organ transplantation is a lifesaving procedure for thousands of people with irreversible end organ diseases. A multidisciplinary approach with inclusion of a pharmacist in the care of transplant recipients is highly desired and may necessitate the addition of transplant pharmacy resources to existing teams to meet these growing needs. By understanding and leveraging the current landscape of leadership priorities, gathering the data to help define the value of pharmacy services, and compiling a formal proposal, one can systematically approach expansion of clinical pharmacy services. This manuscript seeks to provide a framework that can be utilized by pharmacy and transplant administrators, transplant pharmacists, and advocates for transplant pharmacy services for the purpose of evaluating, proposing, and successfully expanding the number of transplant pharmacist resources, including example job descriptions, return on investment examples, and key publications demonstrating the benefit of transplant and pharmacy services.

Effect of an Integrated Clinical Pharmacist on the Drivers of Provider Burnout in the Primary Care Setting.

As the prevalence of provider burnout continues to increase, it is critical to identify interventions that may impact provider satisfaction, such as an integrated clinical pharmacist. This study aimed to assess the perceived effect of pharmacist integration on primary care provider satisfaction and drivers of provider burnout in the primary care setting. A cross-sectional survey with 11 questions across 4 domains was distributed to primary care providers in a large integrated health system. Of 295 providers invited to take the survey, 119 responded (40% response rate). Most providers had worked with a pharmacist for at least 2 years and utilized them weekly or daily. At least 87% of provider respondents strongly agreed or somewhat agreed that the integrated clinical pharmacist reduced their workload by working directly with patients and non-provider staff, improved overall medication use, helped patients meet health goals and quality measures, and overall helped them to effectively manage their panel of patients. Providers found greater meaning in work through the presence of the clinical pharmacist, which allowed them more time to focus on professionally fulfilling aspects of their work and helped them feel less emotional exhaustion. Overall, 91% of providers were extremely satisfied with the clinical pharmacy service. These findings may be used to justify the expansion of clinical pharmacy services in primary care to practice areas experiencing problems with 4 specific drivers of provider burnout: workload and job demands, efficiency and resources, meaning in work, and social support and community at work.

Leveraging telecommuting pharmacists in the post–COVID-19 world

In response to the coronavirus disease 2019 (COVID-19) pandemic, many industries, including pharmacy, rapidly expanded the use of telecommuting workers to assure business continuity and address social distancing needs. Advances in electronic health records and telepharmacy over the past 2 decades enabled pharmacy leaders to easily adapt their practice models to allow for telecommuting alternatives during the pandemic. While these changes were generally intended to be part of the short-term response, the sustained expansion of telecommuting within the pharmacy profession merits further exploration. Documented experience with telepharmacy and telehealth indicate a wide array of clinical and operational pharmacist activities that could be conducted by telecommuters. In addition, experience with telecommuters in other industries suggests potential benefits ranging from improving pharmacists' work-life balance to mitigating postpandemic financial burden. Health care organizations should consider integrating part-time telecommuter pharmacists into contemporary practice models to address other frontline issues and facilitate ongoing expansion of clinical pharmacy services to meet emerging patient needs.

Implementation of a Pilot Pharmacist Testosterone Therapy Management Service

Background: Recent literature findings suggest that opportunities exist to optimize testosterone replacement therapy management. Objective: To evaluate the impact of a pilot clinical pharmacist testosterone therapy management service in a Veterans Affairs primary care setting. Methods: A 6-month, single-clinic, prospective cohort quality improvement project included male patients with an active prescription for testosterone. Patients were excluded if they switched primary care providers or were managed by a specialty clinic. After diagnosis, primary care providers had the option of referring patients for clinical pharmacist testosterone replacement therapy management. The project investigated the impact of pharmacist management on adherence to guideline-defined baseline and therapeutic monitoring, prior authorization workload, time saved by primary care providers, and clinical pharmacist interventions. Results: Sixty patients split between pharmacist management (N = 35) and nonpharmacist management (N = 25) cohorts. Monitoring of baseline parameters was significantly improved with clinical pharmacist management (54% vs 20%, P = 0.0006). Improved baseline monitoring decreased prior authorization team workload as requests were approved on the first submission at a higher rate (100% vs 75.4%, P = 0.06). Pharmacist management increased therapeutic monitoring for assessing symptom improvement (96% vs 26%, P < 0.001), monitoring of testosterone levels (96% vs 61%, P = 0.003), and safety monitoring with complete blood counts (100% vs 83%, P = 0.04). A total of 42 pharmacist–patient encounters saved over 600 minutes of primary care provider time. Conclusion: Clinical pharmacist involvement enhances therapeutic monitoring for male hypogonadism leaving room for expansion of clinical pharmacy services within testosterone replacement therapy management.

Impact of comprehensive pharmacy services on patient centered outcomes in a hematology and oncology clinic

Background: Growing utilization of oral oncolytics has revealed non-adherence due to expense, side effect profiles, and lack of disease state understanding. Prior analyses have supported the integration of a pharmacist to assist in achieving and maintaining medication adherence.Objectives: Assess the longitudinal impact of a clinic-based pharmacist’s services by evaluating the adherence and overall medication experience of patients in a hematology and oncology clinic.Methods: Patients receiving oral oncolytics via pick-up, same-day or overnight delivery from an academic medical center specialty pharmacy following the integration of a clinic-based pharmacist were included in this quality analysis. Data collection was completed for 5 consecutive months in 2016 and 2017. To objectively assess adherence, the primary outcome was adherence rate measured by the medication possession ratio (MPR) calculated with fill date history. Additional time was dedicated by a clinic-based pharmacist in 2017 to provide outreach, discuss barriers, and develop strategies to improve patient adherence. Secondary outcomes evaluated from the 2017 data included the characterization of adherence barriers and the percent of patients who benefited from pharmacist support.Results: The average MPR for the 2016 and 2017 evaluation periods was 0.99 (n = 58) and 0.97 (n = 91), respectively. There were 41% and 47% of patients, respectively, who had an MPR < 1.00, indicating a medication refill delay. Of those patients, 75% and 77%, respectively, had a refill delay that may have been attributable to prescribed titrations or reductions confirmed via chart review, or medication surplus due to prior early refills outside of each study period. Secondary outcome results from the 2017 evaluation showed 86% of patients self-reported a quantity remaining which correlated directly to their calculated MPR. Barriers to adherence were identified by the pharmacist in 44% of patients with 75% having high copayments or other access issues. Assistance was coordinated by the clinical pharmacist for 100% of patients with financial barriers to accessing their medication. The remaining 25% had side effect concerns potentially impacting their adherence in which the pharmacist provided additional support through side effect management and medication reminder strategies.Conclusions: Our quality analysis supports the continued integration and expansion of clinical pharmacy services, which resulted in maintained medication adherence and improved overall treatment experience, in a hematology and oncology clinic.

Physicians\u2019 perspectives on clinical pharmacy services in Northern Sweden: a qualitative study

BackgroundIn many countries, clinical pharmacists are part of health care teams that work to optimize drug therapy and ensure patient safety. However, in Sweden, clinical pharmacy services (CPSs) in hospital settings have not been widely implemented and regional differences exist in the uptake of these services. Physicians’ attitudes toward CPSs and collaborating with clinical pharmacists may facilitate or hinder the implementation and expansion of the CPSs and the role of the clinical pharmacist in hospital wards. The aim of this study was to explore physicians’ perceptions regarding CPSs performed at hospital wards in Northern Sweden.MethodsFace-to-face semi-structured interviews were conducted with a purposive sample of nine physicians who had previously worked with clinical pharmacists between November 2014 and January 2015. Interviews were digitally recorded, transcribed and analysed using a constant comparison method.ResultsDifferent themes emerged regarding physicians’ views of clinical pharmacy; two main interlinked themes were service factors and pharmacist factors. The service was valued and described in a positive way by all physicians. It was seen as an opportunity for them to learn more about pharmacological treatment and also an opportunity to discuss patient medication treatment in detail. Physicians considered that CPSs could improve patient outcomes and they valued continuity and the ability to build a trusting relationship with the pharmacists over time. However, there was a lack of awareness of the CPSs. All physicians knew that one of the pharmacist’s roles is to conduct medication reviews, but most of them were only able to describe a few elements of what this service encompasses. Pharmacists were described as “drug experts” and their recommendations were perceived as clinically relevant. Physicians wanted CPSs to continue and to be implemented in other wards.ConclusionsAll physicians were positive regarding CPSs and were satisfied with the collaboration with the clinical pharmacists. These findings are important for further implementation and expansion of CPSs, particularly in Northern Sweden.

Implementation and Preliminary Clinical Outcomes of a Pharmacist-managed Venous Thromboembolism Clinic for Patients Treated With Rivaroxaban Post Emergency Department Discharge.

The objective was to describe the implementation, work flow, and differences in outcomes between a pharmacist-managed clinic for the outpatient treatment of venous thromboembolism (VTE) using a non-vitamin K oral anticoagulant versus care by a primary care provider (PCP). Patients in the studied health system that are diagnosed with low-risk VTE in the emergency department are often discharged without hospital admission. These patients are treated with a non-vitamin K oral anticoagulant and follow-up either in a pharmacist-managed VTE clinic or with their PCP. Pharmacists in the VTE clinic work independently under a collaborative practice agreement (CPA). An evaluation of 34 patients, 17 in each treatment arm, was conducted to compare the differences in treatment-related outcomes of rivaroxaban when managed by a pharmacist versus a PCP. The primary endpoint was a 6-month composite of anticoagulation treatment-related complications that included a diagnosis of major bleeding, recurrent thromboembolism, or fatality due to either major bleeding or recurrent thromboembolism. Secondary endpoints included number of hospitalizations, adverse events, and medication adherence. There was no difference in the primary endpoint between groups with one occurrence of the composite endpoint in each treatment arm (p=1.000), both of which were recurrent thromboembolic events. Medication adherence assessment was formally performed in eight patients in the pharmacist group versus no patients in the control group. No differences were seen among other secondary endpoints. The pharmacist-managed clinic is a novel expansion of clinical pharmacy services that treats patients with low-risk VTEs with rivaroxaban in the outpatient setting. The evaluation of outcomes provides support that pharmacist-managed care utilizing standardized protocols under a CPA may be as safe as care by a PCP.

Impact of clinical pharmacists in outpatient oncology practices: A review

Published literature describing the effectiveness of outpatient oncology services delivered by clinical pharmacists is summarized. Peer-reviewed articles on studies evaluating the provision of outpatient oncology services by licensed clinical pharmacists in the United States were identified and screened according to a study-specific protocol. Only research publications focused on the care of oncology patients and indicating the evaluation of measurable services and outcomes were selected for review. Data from eligible studies were extracted using a standardized tool, and agreement by a majority of the investigators was required for inclusion of articles in the final review. Eight publications were included in the review; nearly all were published since 2010. All of the included articles reported on results of observational studies in which data sourced from surveys, existing medical or prescription records, or medical cost information were analyzed to measure patient or provider satisfaction (or both) or patient-reported health outcomes. The evaluated evidence indicated that pharmacists were effective in identifying treatment issues and medication misuse, delivering satisfactory and valued services, and finding mechanisms to reduce medical costs or generate revenue to justify continuation or support expansion of clinical pharmacy services. Moreover, in two instances, pharmacists' services were associated with improvements in symptoms reported by oncology patients. Available evidence suggests that outpatient oncology practices may benefit from integrating pharmacists into care models in order to more effectively, efficiently, and holistically address the needs of patients with cancer.

Clinical pharmacists in primary care: Provider satisfaction and perceived impact on quality of care provided.

Purpose:The purpose of this study is to evaluate primary care provider satisfaction and perceived impact of clinical pharmacy services on the disease state management in primary care.Methods:A cross-sectional survey with 24 items and 4 domains was distributed anonymously to pharmacy residency program directors across the United States who were requested to forward the survey to their primary care provider colleagues. Primary care providers were asked to complete the survey.Results:A total of 144 primary care providers responded to the survey, with 130 reporting a clinical pharmacist within their primary care practice and 114 completing the entire survey. Primary care providers report pharmacists positively impact quality of care (mean = 5.5 on Likert scale of 1–6; standard deviation = 0.72), high satisfaction with pharmacy services provided (5.5; standard deviation = 0.79), and no increase in workload as a result of clinical pharmacists (5.5; standard deviation = 0.77). Primary care providers would recommend clinical pharmacists to other primary care practices (5.7; standard deviation = 0.59). Primary care providers perceived specific types of pharmacy services to have the greatest impact on patient care: medication therapy management (38.6%), disease-focused management (29.82%), and medication reconciliation (11.4%). Primary care providers indicated the most valuable disease-focused pharmacy services as diabetes (58.78%), hypertension (9.65%), and pain (11.4%).Conclusion:Primary care providers report high satisfaction with and perceived benefit of clinical pharmacy services in primary care and viewed medication therapy management and disease-focused management of diabetes, hypertension, and pain as the most valuable clinical pharmacy services. These results can be used to inform development or expansion of clinical pharmacy services in primary care.

Expansion of clinical pharmacy through increased use of outpatient pharmacists for anticoagulation services.

The expansion of clinical pharmacy services through increased use of outpatient pharmacists for anticoagulation services is described. Due to the high demand for clinical pharmacist services by patients and medical staff at Harris Health System in Houston, Texas, and the strict budgetary restrictions to improve the quality of care through cost-neutral services, a new telephone anticoagulation monitoring service, provided by clinical pharmacists, was established at four of the busiest anticoagulation ambulatory care centers within the system. One clinical staff pharmacist was trained in each of the four clinics by a clinical pharmacy specialist. Each pharmacist received roughly two weeks of training to provide this service. Implementation of the new anticoagulation monitoring service occurred on April 1, 2013. Data collected between October 2011 and April 2014 revealed significantly more visits per month for the clinical pharmacy service after the implementation of the telephone anticoagulation monitoring service (p=0.011). Redistribution of workflow resulted in a 16% increase in clinical pharmacy patient volume at the ambulatory care clinics (p=0.011). The percentage of International Normalized Ratio values in the therapeutic range, the proportion of hospitalizations due to thromboembolic or bleeding events, work hours per prescription volume, project completion rates, and the number of students precepted did not significantly differ between groups. The implementation of a clinical pharmacy telephone service for patients receiving anticoagulation at an outpatient center resulted in increased patient clinic visits without adversely affecting patient outcomes or increasing personnel or costs.

Pharmacists provide care

Pharmacists provide care

Opportunities and Responsibilities for the Academy in the Medical Home

Opportunities and Responsibilities for the Academy in the Medical Home

Pharmacists: First responders

Pharmacists: First responders

Enhancing Practice Models by Recruiting Pharmacists with Specialty Training

The Director's Forum series is designed to guide pharmacy leaders in establishing patient-centered services in hospitals and health systems. Evaluation of pharmacy practice models across the country promotes the expansion of clinical pharmacy services; some organizations may recruit pharmacists with specialty training. Specialty practice pharmacists are pharmacists who have extensive knowledge and experience in a particular area of pharmacy. Networking is a critical strategy in recruiting the best candidates for specialty roles. This article presents several strategies to assist pharmacy directors in hiring specialty trained pharmacists to enhance their practice model. These strategies apply to building practice models from small hospitals to large academic medical centers. Ultimately, recruitment of the best pharmacists to join the patient care team helps to build the best patient-centered pharmacy service.

Surviving in a cofunded faculty appointment

The expansion of clinical pharmacy services in health systems has contributed to an increased demand for qualified clinical practice faculty.[1][1] In response to this need, many schools of pharmacy have partnered with health systems to develop cofunded, or “shared,” clinical faculty positions.

Development of a Canadian family medicine pharmacy practice experience programme.

Faculties of Pharmacy in Canada must currently provide students with at least 16 weeks of structured pharmacy practice experience. In recent years, the College of Pharmacy at Dalhousie University in Halifax, Nova Scotia, Canada has been developing more practice experience sites in non-institutional settings. One of these is at the Department of Family Medicine at Dalhousie University. This paper describes the development and expansion of clinical pharmacy services in the Family Medicine Clinics, provided by one of the College's clinical faculty members. With those services in place, the clinical pharmacist was ready to begin precepting pharmacy students at the Family Medicine Clinics. A proposal for a family medicine pharmacy practice experience programme was written, accepted and piloted in 1994-95. Following the success of that initial trial, the programme has continued and expanded over the years. Evaluation from the programme participants indicates that experience allows the pharmacy student to successfully complete programme objectives and gain an appreciation for working with other health care professionals to optimize patient care. The Family Medicine Clinics also appreciate the contributions made by the pharmacy students and value the interaction between students training in pharmacy and residents in family medicine.

Expansion of clinical pharmacy services through staff development

A program that trains and uses staff pharmacists for clinical services is described. A position was created that is filled by staff pharmacists on six-week rotations. All full-time pharmacists may participate; they work under the direction and supervision of clinical pharmacists. Basic responsibilities in the rotation include responding to drug information requests, assisting with drug-use evaluation and adverse drug experience programs, assisting with research, writing and editing for newsletters, participating in staff development programs, and reviewing and clarifying drug orders for the skilled-nursing facility. About 60% of eligible pharmacists have participated in this program. The pharmacists have gained new practice skills, greater opportunity for career enhancement, and improved attitudes toward work and colleagues, and the department has been able to provide more clinical services. The focus of the rotation is now being changed from performing clinical tasks to assuming more responsibility for patient outcomes related to drug therapy. A rotating clinical position has enabled staff pharmacists to gain additional nondispensing skills and contribute to the development and maintenance of clinical services.