Cost-benefit analysis with return on investment of clinical pharmacists in the Military Health System.

BACKGROUND: The Defense Health Agency comprises more than 700 military medical, dental, and veterinary facilities and provides care to more than 9.6 million beneficiaries. As medication experts, pharmacists identify opportunities to optimize medication therapy, reduce cost, and increase readiness to support the Defense Health Agency's mission. The Tripler Pilot Project and the Army Polypharmacy Program were used to establish a staffing model of 1 clinical pharmacist for every 6,500 enrolled beneficiaries. No large-scale cost-benefit study within the military health care system has been done, which documents the number of clinical interventions and uses established cost-avoidance (CA) data, to determine the cost-benefit and return on investment (ROI) for clinical pharmacists working in the medical treatment facilities. OBJECTIVE: To validate the patient-centered medical home staffing model across the military health care system using the Tripler Pilot Project results to provide a cost-benefit analysis with an ROI. The secondary goal is to describe the interventions, staffing levels, and US Department of Defense-specific requirements impacting the provision of clinical pharmacy. METHODS: A retrospective analysis of 3 years of encounters by clinical pharmacists in which an intervention was documented in the Tri-Service Workflow (TSWF) form as part of the electronic health record was completed. The analysis used 6 steps to assign CA intervention types and to prevent duplication and overestimation of the ROI. The absolute number of clinical pharmacists was determined using workload criteria defined as at least 20 encounters per month for at least 3 months of each calendar year. The number of clinical pharmacist full-time employees (FTEs) was determined by dividing the number of total active months by 12 months. Attrition was calculated comparing the presence of a unique provider identification between calendar years. The ROI range was calculated by dividing the CA by the total cost of clinical pharmacists using the variables' raw and extrapolated CA based on percentage of documentation template usage and the active clinical pharmacist calculation (absolute and FTE-based). RESULTS: Between January 1, 2017, and December 31, 2019, a total of 1,069,846 encounters by clinical pharmacists were documented in the electronic health record. The TSWF Alternative Input Method form was used by pharmacists to document 616,942 encounters. Forty-three percent of TSWF documented encounters had at least 1 CA intervention. The absolute number of clinical pharmacists associated with a documented encounter in any medical treatment facility ranged from 404 in 2017 to 374 in 2018 and the clinical pharmacist FTEs ranged from 324 in 2017 to 314 in 2019. Annual attrition rates for clinical pharmacists ranged from 15% to 20% (58 to 81 clinical pharmacists) annually. The total CA range was $329,166,543-$534,014,494. The ROI range was between $2 and $4 per dollar spent. CONCLUSIONS: This analysis demonstrated that ambulatory care clinical pharmacists in the Military Health System bring value through a positive ROI. Our study also identified a potential shortage of clinical pharmacists within the Air Force and Navy branches impacting medication management. This can have a negative impact on the readiness of service members, one of the leading priorities of the US Department of Defense.

"Creatures of habit": influential factors to the adoption of computer personalization and accessibility settings.

Purpose: Customizing the accessibility and ease-of-use settings of a computer can improve the overall user experience for people with and without disabilities. However, the adoption of such settings remains poor. This study investigates why various factors may influence people as they personalize and when they choose to integrate those changes into everyday use. Methods: To better understand how these factors may impact people's personalization process, we conducted a series of interviews involving 15 people with and without disabilities across several months in 2020 when computer usage became required due to the COVID-19 lockdown. We used grounded theory to analyze 49 semi-structured interviews with participants. During these interviews, people reflected upon: past attempts at personalization using built-in accessibility or ease-of-use features of their Operating System (OS) or other assistive technologies (AT), current customization activities using the personalization software, Morphic, and future opportunities for personalization systems and features. Results: We identified several barriers, facilitators, and perpetuating factors that can influence why and when people choose to adopt and integrate their personalization changes. We also outline the overall personalization lifecycle, which illustrates when various factors may impact computer personalization. Conclusion: Personalization activities are complex and easily affected by an ecosystem of influential factors that surround them. When paired with the three design considerations and ten lessons learned from this qualitative study, the overall personalization lifecycle may be useful during the design and development of future personalization systems or features for people with and without disabilities.