EXPLORING THE ROLE OF CLINICAL PHARMACISTS IN AN INTEGRATED PRIMARY CARE PROGRAM

ABSTRACT

BACKGROUND: The clinical literature has shown that clinical pharmacists (CP), as part of a care team in primary practice, can produce positive clinical and cost outcomes. Furthermore, embedding a CP in a primary care setting can optimize performance in value-based payment arrangements. OBJECTIVE: The primary objective of this program description was to observe an integrated CP program, describe the role and workflow of the CP, and report preliminary program statistics, which can benefit primary care practices. METHODS: Data management used the eClinicalWorks platform. Data was collected from five different primary care locations in Houston, TX between July 2019 and June 2020, and included demographics and integrated CP activities by visit type (i.e., office, telephonic), service type (i.e., RX adherence, RX care coordination, RX consultation), and service description (i.e., duration, education, clinical chart prep, medication review, medication reconciliation). RESULTS: The integrated clinical pharmacist program incorporated a core care team made up of clinicians, clinical support staff and community care professionals. The study population included elderly adults enrolled in a Medicare Advantage (payer agnostic) plan wherein the patients were mostly Hispanic and belonged to low-income group. The prevalent conditions included type 2 diabetes mellitus, COPD, and heart disease. There was a total of 1,581 distinct encounters (office, N = 498, 31.5%;telephonic, N = 1,083, 68.5%). The average in-office appointment duration was 23.4 minutes. RX adherence (N = 309, 28.6%) was the leading activity followed by RX care coordination (N = 284, 26.2%) and RX consultation (N = 144, 13.3%). Clinical chart prep (N = 191, 38.4%) was the most common office visit activity followed by medication review (N = 145, 29.1%) and individual education (N = 109, 21.9%). The Doximity video app was used during COVID-19 pandemic to coordinate with patients and provide virtual pharmacy support, when telephonic encounters became more prevalent. CONCLUSIONS: This program description highlighted the expanded role of CP interventions integrated into the primary care workflow. In this value-based environment, primary care providers should consider CP who are well suited to offer direct patient care coordination, improve patient adherence and clinical outcomes, and implement cost-effective therapies to their practices. However, further study is needed to examine the impact of integrated pharmacy services on patient outcomes in primary care settings.