Pharmacist and Provider Perceptions of the Clinical and Financial Impact of Pharmacy Services in the ICU

Purpose: To comparatively evaluate the perceptions of pharmacists and providers regarding the clinical and financial outcomes of direct pharmacy services in the intensive care unit (ICU).

Methods: Eighty packets, each containing one pharmacist questionnaire and two provider questionnaires, were distributed at two national meetings of critical care clinical pharmacists. Pharmacists were instructed to complete their questionnaire and ask two providers from the same ICU to complete the provider questionnaires. Questions were designed to solicit frequency, efficiency, and perceptions about the clinical and financial impact (10 point scale) of various pharmacy services, including patient care (8 functions), education (3 functions), administration (3 functions), and scholarship (4 functions). Services were delineated as fundamental, desirable, and optimal.

Results: Forty-one (51%) pharmacists and 47 (29%) providers returned completed questionnaires. Pharmacists had worked in the respective ICU for 8.3±6.4 years and devoted 50±18.9% of their effort to practice functions. In general, providers rated the clinical and financial impact of pharmacy services higher than pharmacists across all functions (e.g. clinical and financial outcomes of providing drug information were rated as 7.9±2.6 and 5±3.9 by pharmacists and 9±1.5 and 7.2±3 by providers, respectively; p=0.015 and p=0.004, respectively). Fundamental services were provided statistically significantly more frequently and were rated more favorably than desirable or optimal services by all respondents. The efficiencies of providing the services without the pharmacist ranged between 40-70% and the median willingness to pay for the pharmacist by providers was $17,500 (IQR, $0-78,750) .

Conclusion: Pharmacists and providers believe most clinical pharmacy services are associated with beneficial clinical and financial outcomes with providers rating most services higher.  Fundamental services are viewed more favorably than desirable or optimal services, possibly because they are provided more frequently or they are required for safe patient care. Considerable inefficiencies are perceived by providers if pharmacy services were to disappear.