Pharmacists as Providers: For Health Care Providers

Pharmacists play an important role on the health care team, collaborating with other providers to improve patient care and reduce health care costs. The Michigan Society of Health-System Pharmacists and MPA Public Affairs Committee developed a resource to help other health care providers learn about the role that pharmacists play in various areas. This will help you understand how to best work with pharmacists to utilize their expertise in various areas and improve the overall health of your patients.

Click on the black bars below for more information about these various areas. Or, click here or on the image at the right to access a booklet that includes all of the areas in one resource.


Anticoagulation

Click here to access the one-page resource on pharmacist involvement in anticoagulation care.

A two-year study at a hospital found that a pharmacy-directed anticoagulation service boosted the quality and efficiency of care for heparin-induced thrombocytopenia (HIT) in patients using direct thrombin inhibitors. During the study there were significant improvements in target levels of time to anticoagulation, 6.4 hours versus 18.9 hours, and time within therapeutic range, 84.7 percent versus 64.4 percent, with pharmacists running the hospital’s anticoagulation service. The key improvement resulting from pharmacist oversight of anticoagulation might have been an increase in positive HIT assays from 55.4 percent to 75.6 percent. That means more patients were treated appropriately and avoided potentially serious adverse events.

Asthma

Click here to access the one-page resource on pharmacist involvement in asthma care.

Poor inhaler technique is frequent in asthma, but its long-term consequences have been seldom assessed. Pharmacists are ideally positioned to teach inhaler technique. In a study involving 727 patients who were in need of improved inhaler technique and adherence, optimal inhaler technique rose from 24 percent to 79 percent after pharmacist-provided training. In addition, a greater change in overall asthma management was seen in those patients who received training from a pharmacist.

Cancer

Click here to access the one-page resource on pharmacist involvement in cancer care.

In a pediatric hospital setting, pharmacist interventions were documented across the general medical, general surgical and hematology-oncology wards for drug therapy changes for cancer patients. Clinical pharmacists reviewed 2,891 patients across the three settings and documented a total of 982 interventions. The acceptance rate of the pharmacists’ active interventions by physicians was high, strengthening existing evidence supporting the confidence that patients, caregivers and other health care professionals have in pharmacists’ contributions toward improving the quality of pediatric cancer care.

Cardiac Care

Click here to access the one-page resource on pharmacist involvement in cardiac care.

In a study, 47 patients were followed over a six-month period. Results showed that increased patient counseling on adherence and lifestyle changes along with increased disease state monitoring and medication adjustment led by a clinical pharmacist can decrease the number of risk factors for cardiovascular disease (CVD). Statistically significant reductions occurred in the total number of CVD risk factors, systolic and diastolic blood pressures and A1c. Reductions also occurred in LDL level, weight, and changes in smoking behavior and physical activity were identified.

Diabetes

Click here to access the one-page resource on pharmacist involvement in diabetes care.

Throughout a six-month period, Hemoglobin A1c levels fell by 2.4 percent in veterans with diabetes at a pharmacist-led diabetes clinic, compared with a 0.2 percent drop in similar patients who did not attend the clinic. This translates to an estimated $9,104 reduction in three-year medical costs for each patient seen in the clinic.

Emergency Medicine

Click here to access the one-page resource on pharmacist involvement in emergency medicine.

An analysis was conducted of pharmacist interventions and resuscitation experiences, including pharmacist participation in a hospital emergency department (ED), and the potential cost avoidance associated with the interventions made by the pharmacists. During the study, 2,150 pharmacist interventions were documented. Pharmacists participated in the care of 1,042 patients triaged to the resuscitation area of the ED. Cost avoidance during the study was determined to be $1,029,776.

Geriatrics

Click here to access the one-page resource on pharmacist involvement in geriatric care.

An observational study at a mid-Michigan community hospital in Ann Arbor found that after its geriatric emergency department (ED) opened, patients 65 years of age or older had a lower risk of hospital admission than when that population was seen in the general ED.

HIV/AIDS

Click here to access the one-page resource on pharmacist involvement in HIV/AIDS care.

A study examined medication adherence for patients using HIV-specialized pharmacies, found that HIV patients were more adherent to their anti-retroviral and comorbid therapies. For patients taking angiotensin converting enzyme or angiotensin receptor blocker (drugs used to treat hypertension), HIV-specialized pharmacy users had significantly higher mean proportion of medication adherence (82.6 percent days covered compared with 79.6 percent of days covered) than in patients not taking advantage of these services. HIV-specialized pharmacy users also had better medication adherence measured as achieving a higher mean proportion of days covered at 83.7 percent than those not utilizing these services (81.3 percent).

Immunizations

Click here to access the one-page resource on pharmacist involvement in providing immunizations.

In a recent study, a dedicated pharmacist immunizer practicing in an indigent care primary health care clinic had a significant impact on increasing adult immunization rates. The immunization needs assessment conducted by the pharmacist demonstrated a significant effect on influenza and pertussis vaccination rates. The use of an identical tool by other health care providers did not have an impact on individual vaccine rates or the likelihood of patients who were considered current with vaccinations. The availability of a pharmacist immunizer had a significant impact on the number of patients who were current on all immunizations at the completion of the study.

Intensive Care

Click here to access the one-page resource on pharmacist involvement in intensive care.

Correct dosing of antimicrobial drugs in septic patients receiving continuous renal replacement therapy (CRRT) is complex. A recent study aimed to evaluate the effects of dosing adjustments performed by pharmacists on the length of intensive care unit (ICU) stay, ICU cost and antimicrobial adverse drug events (ADEs). Pharmacists made 183 antimicrobial dosing adjustment recommendations for septic patients receiving CRRT. Dosing adjustments were related to a reduced length of ICU stay from 10.7 days to 7.7 days in the intervention group, and to cost savings of $3,525 per septic patient receiving CRRT in the ICU.

Nephrology

Click here to access the one-page resource on pharmacist involvement in nephrology.

In four studies investigating the number and type of clinical pharmacist interventions and physician acceptance rates, a mean acceptance rate of 79 percent was reported. The most common reported drug-related problems were incorrect dosing, the need for additional pharmacotherapy and medical record discrepancies. These four controlled trials (three of which were randomised) revealed that clinical pharmacy interventions had a positive impact on patient-oriented outcomes in the intervention group as compared to the available standard of care. In addition, most of the studies reported that a significantly higher proportion of patients managed by a clinical pharmacist maintained relevant target ranges (e.g., haemoglobin and haematocrit) as compared to patients receiving standard care.

Organ Transplant

Click here to access the one-page resource on pharmacist involvement in organ transplant care.

Over a five-week period, three transplant pharmacists recorded all interventions that they made practicing under a collaborative practice agreement with a physician. A total of 1,060 interventions were made by the transplant pharmacists during this time period. Total estimated savings were more than $107,000, or roughly $36,000 per pharmacist, during the study period. When these results are extrapolated out further, it is estimated that each transplant pharmacist would save more than $373,000 per year for the institution.

Osteoporosis

Click here to access the one-page resource on pharmacist involvement in osteoporosis care.

A pharmacist-led quality assurance program targeting osteoporosis management was evaluated in two primary care (general practice) clinics. Significant improvements were seen in the prescription of anti-osteoporosis medicines, vitamin D and calcium supplements. The proportion of patients without documented contraindications to osteoporosis therapies who were prescribed an anti-osteoporosis medicine increased significantly (59 percent vs. 70 percent). The proportion of patients for whom vitamin D and/or calcium supplement use was documented also increased significantly (63.9 percent vs. 85.4 percent).

Pain Management

Click here to access the one-page resource on pharmacist involvement in pain management.

Over a six-month period, a hospital developed a novel, pharmacist-directed, pain management service. At nine months post-implementation, 1,335 interventions were documented with an estimated indirect cost savings of $1,622,449. Of these interventions, 81 percent were the result of prescriber consults, with opioid stewardship comprising the remaining 19 percent. The acceptance rate of pharmacist recommendations was 88 percent. The group won a Best Practices Award from the American Society of Health-System Pharmacists for this study.

Pediatrics

Click here to access the one-page resource on pharmacist involvement in pediatric care.

Pharmacy professionals from a Michigan college of pharmacy and state pharmacy association collaborated on a statewide initiative to standardize the concentrations of compounded oral liquids for pediatric patients. Prior to this initiative, standard concentrations of compounded oral liquids had not been established, which was reported to contribute to medication errors and patient harm. This study resulted in creation of a Web site, www.MIpedscompounds.org, containing standard concentrations, a toolkit for criteria of use and additional resources available to all health care providers. This initiative has received national recognition, including an award from the Institute for Safe Medication Practices. The group continues to promote the standards, with the goal of expanding them to the national level.

Pharmacy Technician Practice

Click here to access the one-page resource on pharmacy technician practice.

Tech-check-tech (TCT), a practice model in which pharmacy technicians rather than pharmacists check the accuracy of order filling by other technicians, has been the subject of many recent literature reviews. Across 11 published studies, the accuracy of TCT protocols was comparable to a pharmacist checking for prescription order accuracy.

Point-of-Care Testing

Click here to access the one-page resource on pharmacist involvement in point-of-care testing.

As part of an ongoing initiative in Michigan, Minnesota and Nebraska, a study was conducted to evaluate pharmacy-based point-of-care testing. More than 90 percent of patients that used the service were satisfied with the quality of care and health outcomes achieved. In addition, patients with a rapid diagnostic test for flu had lower influenza-related health care costs ($62.46) than patients who had no rapid diagnostic test ($192.83).

Public Safety

Click here to access the one-page resource on pharmacist involvement in public safety.

Pharmacy practice can provide a convenient arena for public health community outreach during an emergency. Consumers shop at food retails and pharmacies an average of 1.9 times per week, and about 93 percent of those consumers live within five miles of a community pharmacy. Coordination and planning between health departments and pharmacies to offer education materials to the public as well as aid during disaster response can ensure more consistent messaging that reaches all populations in a community, leading to improved access to needed medication.