Impact analysis of virtual transplant ambulatory pharmacist during COVID-19

ABSTRACT

Purpose: During the COVID-19 pandemic, transplant centers were challenged to meet the demand for new telemedicine strategies. High-risk immunocompromised patients, such as lung transplant recipients (LTR) require close follow-up due to their medical complexity and need for frequent medication changes. The pandemic significantly limited the ability of lung transplant providers (LTP) to safely conduct face-to-face clinic visits. Transplant pharmacists, previously unable to provide medication management visits for all patients due to time and space restraints of clinic, were now able to conduct virtual telehealth visits to assist LTP in the transition to telemedicine. Methods: A retrospective chart review of telephone encounters from cardiothoracic pharmacists (CTRx) at our center from March to September 2020 was completed. LTR scheduled for clinic visits with LTP were called prior to the visit by CTRx who conducted chart reviews, medication reconciliations, adherence assessments, and medication access assistance. Clinical recommendations were then communicated directly to the LTP and documented in patient electronic medical records. The primary outcome was the number of pharmacist-driven clinical interventions made during COVID-19 virtual lung transplant visits. Secondary endpoints included the total number of medication discrepancies, average number of interventions, and average number of discrepancies found per visit. Results: From March to September 2020 the CTRx conducted 385 virtual visits on 157 LTR with an average of 23.4 minutes spent per visit. There were 864 total interventions made by CTRx and a total of 778 medication discrepancies identified. An average of 2.8 interventions were sent to LTP per visit. The most common interventions made were medication education (20.8%), adherence counseling (19.5%), update on adherence level (20.4%), and reinforcement of social distancing and COVID-19 precautions (17.1%). There was an average number of 2.5 medication discrepancies identified out from an average of 22.6 medications reconciled per visit. (Table 1) Conclusions: Implementation of CTRx telehealth visits has potential for increased patient access to pharmacy care, improved accuracy of medication lists and increased collaboration with LTP given the flexibility that telemedicine provides. Further investigation is needed to determine the significance of CTRx clinical interventions on clinical patient outcomes.