Patient care impact and potential cost avoidance generated by student pharmacists during Advanced Pharmacy Practice Experiences

Purpose: Student pharmacist contributions to patient care have been documented in the literature.  However, exploration of potential cost avoidance is warranted. This investigation analyzed interventions documented by fourth-year professional (P4) Northeastern University student pharmacists during Advanced Pharmacy Practice Experience (APPEs) in outpatient and inpatient settings. We evaluated student impact on patient care and potential cost avoidance.

Methods: P4 pharmacy students were trained to use a school-wide web-based intervention system (PxDx, E-Value) and encouraged to document interventions throughout 36 weeks of APPEs. The database was retrospectively analyzed to review characteristics of interventions documented during the 2011-12 APPE cycle. An evaluation was conducted to assess the potential cost avoidance associated with the interventions. Estimates of costs were derived from a comprehensive literature review and adjusted to 2011 dollars based on the consumer price index for medical care.

Results: Eighty-seven students (71%) documented 5775 interventions (3041 inpatient and 2734 outpatient) over 36 weeks with an estimated potential total cost avoidance of $780,876. The most common intervention categories reported were patient education (26%) and drug information (26%). Students also reported that 2082 (36%) potential adverse drug events (ADEs) were prevented. Seventy-one percent of interventions were accepted as is, 26% were informational only, and 3% of the recommendations were rejected. Students identified 93% of interventions as having a clinically significant impact on patient care. While we could not assign cost savings to each intervention, the intervention categories associated with the greatest cost avoidance were ADE prevented ($203,742), patient education ($148,745) drug information ($145, 201), addition of medication with clinical indication ($84,267), and therapeutic dose adjustment ($32,126).

Conclusions: P4 student pharmacists represent a valuable resource to both the inpatient and outpatient pharmacy settings. They can make a positive impact on patient care while also contributing to cost avoidance. This analysis provides the foundation for future work.