Category: Federal Forum Posters
Purpose: Primary care is presently facing a shortage of available providers. This issue has been compounded by expanded coverage under the Affordable Care Act (ACA) and an aging U.S. population. The Veteran Affairs (VA) has incorporated clinical pharmacy specialists (CPS) into ambulatory care teams to address this issue. The goal of this project was to implement a new patient medication intake process in a primary care setting to assess if pharmacist intervention would provide beneficial time savings for providers, improve veteran and provider satisfaction, and providing cost avoidance through recommendations.
Methods: The pharmacy resident gave primary care providers (PCPs) a survey prior to the start of the project assessing the amount of time spent performing medication reconciliation with veterans during intake appointments and satisfaction in completing this task. Veterans were included in the study if they had established care with the VA and were scheduled for an intake appointment during the data collection time period. Veterans were excluded if they were unable to complete the telephone visit for an unspecified reason or did not show up for their intake appointment. Veterans were contacted via telephone at least two weeks prior to their scheduled intake appointment with a PCP. The duration of this call was recorded along with baseline demographics and pertinent medication information. Based on the information gathered during this call appropriate recommendations were made to the PCP. Veterans were asked at the end of their intake appointment if they found that the service was a benefit to them. After implementation of interventions, the cost avoidance of each recommendation was then calculated. PCPs were provided with an additional survey at the end of data collection.
Results: Of the 31 veterans who met the inclusion criteria 28 were included in the study. Surveys were completed by 4 PCPs with an average time savings of 13.8 minutes. On average, 14.6 minutes were devoted to each telephone visit, with an additional 18.3 minutes spent on completing documentation and chart review. Ninety-six percent of veterans, 27 out of 28, felt that the service was a benefit to them. The average change in satisfaction points amongst the PCP surveys was plus 0.5 points. The overall cost avoidance per recommendation was $466.09, with a total cost avoidance of $10,254.00 based on 22 recommendations.
Conclusion: Pharmacist interventions appear to save time for PCPs during intake appointments. This is consistent with the findings of previous VA initiatives in this area. The veterans had near unanimous consensus that the service was a benefit to them from a pharmacy and policy standpoint. Providers also saw modest improvement in their level of satisfaction. The recommendations resulted in cost avoidance despite the small sample size. This contributes to the field of knowledge that CPS involvement improves the quality of care and clinical outcomes of veterans.
Hal Clark– Pharmacy Resident, VA Pittsburgh Healthcare System, Pittsburgh, PA