As the population ages and becomes sicker, patients require more prescriptions for more specialized drugs. In fact, more than half of seniors are taking four or more prescription drugs. This raises the risk for medication errors, negative drug interactions, and other adverse drug events. Medication-related errors cost the U.S. health care system approximately $40 billion each year.
At the same time, many providers have taken on risk for patient outcomes and total cost of care. This creates additional incentive to ensure proper medication management for patients. Primary care providers (PCPs) that take more active roles in managing patient care, including helping them with their medications, are known to improve outcomes and drive down costs.
PCPs are facing increasing rates of burnout and mounting demands on their time. Considering the strain on PCPs, provider organizations have been evaluating the role that pharmacy can play in primary care settings.
Pharmacists can lighten PCP's workload and improve patient care
By offloading medication-related tasks to pharmacists, PCPs can spend more time on patient care. Organizations piloting pharmacist roles in primary care settings have seen that pharmacists can have a large impact.
In a study across four health systems in Minnesota, researchers interviewed 16 PCPs who had been working with pharmacists. After working with a pharmacist, the PCPs reported decreased workload and mental exhaustion, achievement of quality measures, enhanced professional learning, and satisfaction and reassurance that their patients are receiving the right care.
Despite pharmacy's great potential in improving outcomes in primary care, not every provider organization is investing in pharmacy support. An Advisory Board survey found that on average, 50% of primary care clinics have dedicated pharmacy support, though this person may be shared across multiple sites.
Integrating pharmacy expertise in primary care settings may look different for each organization, depending on the goals that they are trying to achieve. Read on for the four questions health system leaders should ask to guide their deployment of pharmacy in primary care.
#1: What is your program's primary goal?
Most organizations are pursuing one of two goals with their primary care pharmacists: comprehensive management for the highest-risk patients, or quality metric improvement for patients with specific conditions, such as diabetes, hepatitis C, or COPD.
Determining which goal makes the most sense for your organization depends on the type of risk that you have taken on. Are there certain penalties, such as 30-day readmissions, that you are trying to avoid? Has your organization taken on broader risk across a large portion of your patients?
These factors are important to keep in mind in the early stages of designing your program, as they will inform how you structure your program and how you ultimately measure success.
#2: Who is the pharmacist's end customer?
Organizations can choose whether pharmacists work directly with patients or work exclusively with the PCP. Pharmacists who interact with patients are typically off-loading medication-related tasks from a prescriber.
This can include meeting directly with patients for medication therapy management, providing medication education, and resolving any barriers to medication adherence. Alternatively, pharmacists who work directly with the PCP typically act as a support for prescriber decision-making. They can educate providers on certain medications, review patient charts, and make medication-related recommendations.
Organizations should consider how they want to utilize pharmacists to best meet their program's goals. Pharmacists who work with patients can provide comprehensive medication management, which can help free up some of the PCP's time while ensuring quality patient care. However, pharmacists who work with PCPs directly are often able to cover a greater number of patients more efficiently.
#3: Where should you locate pharmacists?
Whether pharmacists are working directly with patients or behind the scenes with prescribers, they may be located either in a central office or embedded in the clinics. There are a few differentiators between these models:
- Embedded pharmacists may lead to higher PCP buy-in and satisfaction with the pharmacist, because providers can easily reach them for a face-to-face consult when they have a question or want them to meet with a patient.
- A centralized model is much easier to scale, since its remote patient management enables larger patient panels. Centralized models also have the benefit of not requiring space within the clinic walls, which can be helpful when clinic space is in high demand.
In an Advisory Board survey, we found that organizations most commonly embed pharmacists across multiple clinics, rotating between different sites. However, organizations that chose this model should be aware of the increased potential for staff burnout as folks move from location to location.
#4: How should you approach staffing considerations, such as staffing ratio or panel size?
Staffing considerations are often the most complex piece of the puzzle when it comes to program design. There are some key factors to keep in mind.
- Visit format: telephone visits take about half the time of face-to-face appointments.
- Work status: full-time pharmacists will typically grow an established patient panel faster than part-time pharmacists.
- Support staff availability: When pharmacists are paired with a dedicated pharmacy technician, medical assistant, or nurse, their capacity can increase as much as 50%.
- Other responsibilities: Pharmacists without clearly protected time may be expected to manage provider education and quality assurance tasks as well as triage medication questions from patients and providers. Organizations need to decide if the pharmacist will be fully focused on certain patient care goals, or if they will be splitting their time across multiple responsibilities.
4 final tips to get started with deploying pharmacy in primary care
- Information will always be imperfect. Pharmacy leaders often want to look for perfect information to design an air-tight program model. Unfortunately, that is rarely, if ever possible—there are too many variables at play. Be comfortable making initial, educated assumptions about staffing needs and visit volumes and plan to revise as you go.
- Administrative staff are integral to program success. Pharmacy technicians who can manage patient identification, outreach, and data tracking functions extend the pharmacist's capacity. If you are requesting staff, ask for both a pharmacist and a pharmacy technician.
- Internal guidelines can help maximize pharmacists' time and impact. For example, "graduation criteria" can guide pharmacists on when to stop meeting with a patient. This may look like meeting certain benchmarks (e.g., no emergency department or inpatient visits for six months, achievement of care plan goals), or after meeting a certain number of visits. Having such structures in place can free up the pharmacist's capacity to see new patients.
- Robust EHR functionality can help ensure seamless workflows and communication. Work with your IT team early and often to build out the necessary tools to properly integrate pharmacists into their sites of care.