Krista Lobkovich, Pharm.D., 2019 candidate, Ferris State University College of Pharmacy
Tiffany Jenkins, Pharm.D., BCACP, population health pharmacy manager, Affinia Health Network
Pharmacy practice has changed drastically over the last few decades. Transitioning from a process-based to a more clinically-based profession, pharmacy today requires many new responsibilities including medication therapy management (MTM), integration of pharmacy student and resident education, collaborative practice agreements, statewide protocols, immunizations and new legislation regarding controlled substances. With these changes and updates, one begins to wonder how a pharmacist can get everything done during an average eight-twelve hour work day. Luckily, behind every pharmacist is a team of pharmacy extenders who have been trained and integrated, to some extent, into these new responsibilities.
Pharmacy extenders most commonly include technicians, students and residents. A 2014 study reported that the integration of pharmacy students into a community teaching hospital improved HCAHPS scores and increased the number of pharmacy interventions per patient per day from 0.9 to 1.41. Additionally, this study reported that with the integration of pharmacy students into the workflow, the patient to pharmacy staff member ratio decreased from 30:1 to 7:11. This implies that the inclusion of pharmacy extenders allows for a decreased workload and more thorough patient interviews. An additional study from 2017 reported that the integration of pharmacy students into a level II trauma center resulted in a monthly cost avoidance of $3,739 and increased medical interventions that optimized medication regimens.2 While these two studies focused on pharmacy students as extenders, it can be extrapolated that the impact of technicians and residents would be similar since the responsibilities are comparable.
Pharmacy preceptors from across the state, including those from Henry Ford Hospital, Ferris State University, Harper University Hospital, Bronson Methodist Hospital, Genesys Health and Wayne State University all utilize pharmacy students and residents in very similar ways. They are responsible for direct patient care activities including: medication reconciliation, patient history and objective data collection, education and counseling, collecting in-clinic vitals and necessary point-of-care tests, addressing drug information questions, navigating insurance complications and providing education for medical residents and pharmacy staff. Students and residents in many cases are also responsible for documenting their interactions in the patient's chart with a cosign from their preceptor. Most of the time pharmacy students and residents act independently, while still under supervision of their preceptor. This independence allows the pharmacist to engage with more patients each day and make more meaningful interventions each day.
The other common pharmacy extender is the pharmacy technician. Their responsibilities vary from those of students and residents, but are nonetheless helpful in expanding the pharmacist's clinical reach. Northern Physicians Organization, Spectrum Health, Community Care Services and Medical Advantage Group reported using their technicians outside of traditional dispensing activities such as for scheduling and documenting MTM encounters, calling patients to follow up on antibiotics, checking MCIR for immunizations, evaluating medication adherence and keeping patients on target refill dates. Some clinical sites also reported using technicians for administrative duties including: scheduling and rescheduling patient appointments, inputting billing codes, making sure practice agreements and statewide protocols are up to date and on file, management of licensure requirements, navigating insurance problems, writing schedules for the pharmacist and technicians and assisting with drug recalls and shortages.
Together students, residents and technicians work tirelessly to increase the clinical impact of the pharmacist. These pharmacy extenders directly assist the pharmacist and indirectly assist other providers working towards the Quadruple Aim focus. By extending the clinical reach of the pharmacist, the extenders work to improve healthcare outcomes, lower costs and ensure satisfaction for both patients and providers, which in this case is the pharmacist.
1. Delgado O, Kernan WP, Knoer SJ. Advancing the pharmacy practice model in a community teaching hospital by expanding student rotations. Am J Health Syst Pharm. 2014 Nov 1;71(21):1871-6.
2. Smith L, Samai K, Peshek S, Kimbrell B. Impact of pharmacy students on a level II trauma center: Int J Trauma Nurs. 2017;24(4):231-5.