Practice Transformation Driven through Academic Partnerships

Improving patient safety and access to healthcare: The role of pharmacist-managed clinics in optimizing therapeutic outcomes

Contemporary patient care requires a multidisciplinary approach to monitoring, assessing, and managing diseases. Promoting multidisciplinary approaches encourages the purposeful participation of many healthcare professionals and harnessing their combined knowledge to provide tailored treatment plans. Pharmacists, skilled and knowledgeable professionals in medication management, drug-related problems, and disease prevention, can offer vital interventions that contribute to improved patient outcomes. Advances in healthcare and information technology have expanded pharmacists' professional roles and made them essential in healthcare. Pharmacist-managed clinics (PMCs), an innovative healthcare approach, could potentially improve patient safety, satisfaction, accessibility, and affordability to quality healthcare. Spread across the healthcare continuum, pharmacists have a well-defined role in providing comprehensive pharmaceutical care and interprofessional collaboration, further reinforcing the necessity of establishing PMCs. This narrative review aims to compile and summarize information on PMCs from PubMed, Scopus, Web of Science, and Google Scholar till December 2023. The PMC shortlist covers specialties such as cardiovascular, hematologic, endocrine, pain medicine, respiratory medicine, infectious diseases, gastrointestinal, nephrology, neurology, and oncology. Pharmacists in disease-specific PMCs have demonstrated improved treatment outcomes and access to specialty care. Additionally, based on peer-reviewed literature, the review also highlights how PMCs enhance the pharmacist's role in improving disease-specific outcomes, overall quality of care, and medication management. The inclusion criteria are randomized controlled trials, case-control studies, cohort studies, and pre-post studies involving patients from cardiology, hematology, endocrinology, pain medicine, respiratory medicine, infectious diseases, neurology, nephrology, gastroenterology, and oncology specialties, focusing on pharmacist-driven clinics, published in English, and covering any geographical location. The exclusion criteria include review articles, proposed models, commentaries, editorials, and those published in languages other than English. Our findings reveal that PMCs are underutilized globally. PMCs work better in developed countries, possibly on account of robust healthcare infrastructure, adequate healthcare budgets, availability of trained pharmacists, and supportive regulatory environments. The review found that pharmacist-led interventions, such as medication monitoring and patient education, significantly enhance therapeutic outcomes. Pharmacist Managed Clinics improve affordability and acceptability, expanding healthcare access in outpatient and inpatient settings. This review also highlights the critical need for implementing PMCs to improve healthcare delivery, particularly in providing comprehensive and accessible services in developing countries.

Development, Pilot, and Evaluation of a Qualitative Documentation Tool for Pharmacists to Share High Impact Patient Intervention Stories

Background: Community pharmacists are often the most accessible member of the healthcare team to many patients and can play a key role in managing their chronic conditions, such as diabetes or heart disease, through enhanced pharmacy services. Despite their accessibility, pharmacy services are often underutilized due, in part, to a lack of adequate reimbursement models that comprehensively encapsulate all elements of those pharmacy services. While routine documentation of services does collect certain qualitative data, they do not always indicate the nuance of the full scope of services with resulting robust impact and value of those services for the patient and healthcare system. Objective: To develop and pilot an online reporting tool for pharmacist documentation of high impact patient intervention "stories" that includes the nuances of care provision processes in outpatient pharmacy settings that promote positive outcomes. Methods: An online Patient Stories Reporting Tool (PRST) was developed to allow outpatient pharmacists to document details on distinct direct patient care encounters, or "stories", that they felt showcased their value. Documentation through PSRT included limited quantitative data and qualitative data with a focus on a free response narrative for the "story". In a pilot, the PSRT was distributed to 18 pharmacists across 16 practice sites from one partnering pharmacy organization. Qualitative data, the focus of the included analysis, was collected, assessed by project team members, and organized by intervention types. Results: Forty-seven stories involving 17 pharmacists across 13 practice sites from August 2021 to March 2023 were reported. Three types of key intervention stories were identified including General Patient Education (7 stories), Medication Optimization (20 stories), and Cost Reduction (20 stories). Given the nature and scope of this initial pilot, one story for each of the three most prevalent intervention types was identified as exemplifying the types of stories the tool can collect and are subsequently discussed in detail. Conclusions: The three selected stories help to characterize the services pharmacists provide, the critical components of pharmacist-patient interactions, and the value of sharing these stories utilizing tools such as the PSRT. Through these stories, the PSRT also begins to record the nuances of pharmacist interventions and the impact they can make in a patient's healthcare journey. Potential applications of the tool are multivarious including supporting improvements in the perception of pharmacists' roles on the healthcare team and justifying expansion of reimbursement models.

Establishment of a Framework to Support Multi-Faceted Initiatives for Pharmacy-Practice Transformation: Lessons Learned

We describe the first two years of a multifaceted, five-year program to support sustainable pharmacist-provided health services in Alaska. In 2018, the Alaska Pharmacists Association funded the Sustainable Education and Training Model under Pharmacist as Providers (SETMuPP) to train and support pharmacists to navigate the insurance medical billing process for nondispensing healthcare services. The SETMuPP employed a three-pillar implementation approach: (1) training and practice support infrastructure, (2) PharmD curriculum augmentation, and (3) advocacy and legislative support. The first two years have demonstrated the effectiveness of triad partnerships between professional associations, state policy makers, and academic centers to catalyze meaningful practice transformation.