Justifying the integration of a clinical pharmacist into a primary care team

Purpose: To evaluate the sustainability of clinical pharmacy services in one primary care clinic within a large, integrated, county-based health system serving a diverse, low-income population.

Methods:   A PGY2 pharmacy resident established a clinical practice (0.5 FTE) in a primary care clinic that had not previously included a pharmacist.  Nine months following initiation of services, the impact of the practice was evaluated from several perspectives as part of a proposal for permanent staffing.   Elements of impact evaluated to justify sustainability of the pharmacy practice included fiscal measures (patient encounters, fee-for-service billing, and institutional cost savings opportunities), quality improvement initiatives (impact on disease specific quality measures), provider and patient satisfaction.

Results: Pharmacy services demonstrated the potential to generate $55,650 in revenue through fee-for-service billing.  Reduction in emergency department (ED) and hospital visits through medication management services for uninsured patients ($124,948), and reductions in overall health costs for patients enrolled in an Accountable Care pilot program ($69,677) had the potential to produce $194,625 in cost-savings for the organization.  A redesigned approach to asthma care including a clinical pharmacist resulted in a 21.7 percent increase in patients receiving optimal asthma care, as defined by Minnesota Community Measures.  Patient satisfaction surveys revealed a high level of satisfaction.  Additionally, patients indicated that they were very likely (86%) or likely (14%) to suggest a visit with a clinical pharmacist to a friend. Medical providers and staff were likewise very supportive of continuing clinical pharmacy services in the clinic with 90 percent of staff indicating that presence of the clinical pharmacist has impacted the quality care in the clinic.

Conclusion: Integration of clinical pharmacy services resulted in improvements in quality and cost savings.  Combined with revenue opportunities, data and experience suggest justification for a permanent clinical pharmacy position at this clinic.