PCImpact: A modeling tool for forecasting impact of primary care pharmacist services

Background: The role of the community pharmacist has traditionally been a medication dispenser; however, community pharmacists’ responsibilities must expand to include more direct patient care services in order to transform primary care practice. Objectives: Use case-based scenarios to (1) determine factors that contribute to positive and negative consumer perceptions of expanded community pharmacist patient care roles, (2) identify facilitators and barriers that contribute to consumer perceptions of the value of expanded community pharmacist patient care services, and (3) develop a successful approach and strategies for increasing consumer advocacy for the value of expanded community pharmacist patient care services. Methods: Two consumer focus groups used scenario-based guided discussions and Likert scale questionnaires to elicit consumer reactions, facilitators, and barriers to expanded community pharmacist services. Results: Convenience, timeliness, and accessibility were common positive reactions across all 3 scenarios. Team approach to care and trust were viewed as major facilitators. Participant concerns included uncertainty about pharmacist training and qualifications, privacy, pharmacists’ limited bandwidth to accept new tasks, and potential increased patient costs. Common barriers to service uptake included a lack of insurance payment and physician preference to provide the services. Conclusion: Consumer unfamiliarity with non-traditional community pharmacist services is likely an influencer of consumers’ hesitancy to utilize such services; therefore, an opportunity exists to engage consumers and advocacy organizations in supporting expanded community pharmacist roles. This study can inform consumers, advocates, community pharmacists, primary care providers, and community-based organizations on methods to shape consumer perceptions on the value of community pharmacist expanded services.

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Return-On-Investment for Billable Pharmacist-Provided Services in the Primary Care Setting

Journal of Pharmacy Practice ◽

10.1177/08971900211013194 ◽

2021 ◽

pp. 089719002110131

Author(s):

Thuy Tran ◽

Leticia R. Moczygemba ◽

Kerri T. Musselman

Keyword(s):

Primary Care ◽

Return On Investment ◽

Business Models ◽

High Volume ◽

Full Time ◽

Sustainable Business ◽

Primary Care Teams ◽

The Cost ◽

Pharmacist Services ◽

The Impact

Background: Pharmacists are increasingly fulfilling roles on primary care teams, yet business models for pharmacist services in these settings have not been optimized. This study describes how an ambulatory care pharmacy department implemented various billing methods to generate revenue for pharmacist services. Objectives: (1) Describe pharmacist-delivered billable and non-billable services; and (2) Assess the impact of various billing methods on the return-on-investment (ROI) for billable services. Methods: This study was conducted from September 2016 to August 2017 in Virginia. Pharmacist time spent performing billable encounters using current procedural technology (CPT) codes (e.g., incident-to a physician, annual wellness visits) was calculated. Encounters eligible for the hospital-based facility (G0463) and chronic care management (CCM) codes were considered to be potentially billable services. The ROI was calculated for billable and potentially billable services. Results: A total of 948.3 hours (0.46 full-time equivalents (FTE)), 17% of all clinical services, were billed using CPT codes. This resulted in a total revenue of $173,638.66. Missed revenue from not billing for the G0463 and CCM codes was $68,268.37. The cost of pharmacist services for 0.46 FTE was $78,613.08, resulting in a ROI for billed pharmacist services of 1.2:1. The ROI increased to 1.6:1 when considering potentially billable services. Conclusion: It is feasible to have a positive ROI for billable pharmacist services. To achieve a sustainable business model, there must be a high volume of billable services. G0463 and CCM codes are often underutilized, yet represent significant opportunities in revenue for pharmacist services and should be pursued.

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Barriers to and facilitators of the implementation of pharmacist services in primary care clinics: a scoping review protocol

BMJ Open ◽

10.1136/bmjopen-2021-057191 ◽

2022 ◽

Vol 12 (1) ◽

pp. e057191

Author(s):

Haixin Li ◽

Xujian Liang ◽

Yang Wang ◽

Yiting Lu ◽

Zhiling Deng ◽

...

Keyword(s):

Primary Care ◽

Scoping Review ◽

Inappropriate Medication ◽

Grey Literature ◽

Primary Care Clinics ◽

Health Authorities ◽

Ethical Approval ◽

Review Protocol ◽

Available Information ◽

Pharmacist Services

IntroductionInappropriate medication use is a leading cause of avoidable harm in health systems and is particularly severe in primary care settings. Evidence has shown that the integration of pharmacists into primary care clinics has favourable satisfaction and effectiveness in health outcomes. However, barriers to and facilitators of pharmacist services in these settings have not been comprehensively reviewed. Therefore, this scoping review aims to map and examine the literature available on the barriers to and facilitators of the implementation of pharmacist services in primary care clinics to guide future implementation research.Methods and analysisThis scoping review will be undertaken following the six-stage framework developed by Arksey and O’Malley and be guided by recommendations by Levac et al. Eight electronic databases (PubMed, Embase, Scopus, Web of Science, CINAHL, PsycINFO, CNKI and Wanfang) will be searched. Reference lists and related citations, and grey literature from websites will be searched manually. Available information that has been reported in Chinese or English up to 31 August 2021 will be included. Studies will be selected and screened by two reviewers independently. Findings from the included studies will be extracted by two independent reviewers and supervised by a third reviewer. A content analysis of the findings will be performed using MAXQDA 2020.Ethics and disseminationEthical approval will not be required for this scoping review, as all data and information will be obtained from publicly available literature. The findings of this scoping review will be shared with healthcare managers in primary care institutions and health authorities as well as disseminated via publication in a peer-reviewed journal.

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Expansion and Evaluation of Pharmacist Services in Primary Care

Pharmacy ◽

10.3390/pharmacy8030124 ◽

2020 ◽

Vol 8 (3) ◽

pp. 124

Author(s):

Katherine J. Hartkopf ◽

Kristina M. Heimerl ◽

Kayla M. McGowan ◽

Brian G. Arndt

Keyword(s):

Primary Care ◽

Usual Care ◽

Outcome Measures ◽

Pressure Control ◽

Service Evaluation ◽

Primary Objective ◽

Care Pathways ◽

Health Initiatives ◽

Pharmacist Services ◽

Statin Use

Challenges with primary care access and overextended providers present opportunities for pharmacists as patient care extenders for chronic disease management. The primary objective was to align primary care pharmacist services with organizational priorities and improve patient clinical outcomes. The secondary objective was to develop a technological strategy for service evaluation. An interdisciplinary workgroup developed primary care pharmacist services focused on improving performance measures and supporting the care team in alignment with ongoing population health initiatives. Pharmacist collaborative practice agreements (CPAs) were developed and implemented. An electronic dashboard was developed to capture service outcome measures. Blood pressure control to <140/90 mmHg was achieved in 74.15% of patients who engaged with primary care pharmacists versus 41.53% of eligible patients electing to follow usual care pathways. Appropriate statin use was higher in patients engaged with primary care pharmacists than in eligible patients electing to follow usual care pathways both for diabetes and ischemic vascular disease (12.4% and 2.2% higher, respectively). Seventeen of 54 possible process and outcome measures were identified and incorporated into an electronic dashboard. Primary care pharmacist services improve hypertension control and statin use. Service outcomes can be measured with discrete data from the electronic health record (EHR), and should align with organizational priorities.

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Implementing primary care pharmacist services: Go upstream in the world of value-based payment models

Research in Social and Administrative Pharmacy ◽

10.1016/j.sapharm.2016.12.012 ◽

2017 ◽

Vol 13 (5) ◽

pp. 892-895 ◽

Cited By ~ 8

Author(s):

Marie A. Smith

Keyword(s):

Primary Care ◽

The World ◽

Pharmacist Services ◽

Payment Models

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From Pilot to Scale, the 5 Year Growth of a Primary Care Pharmacist Model

Pharmacy ◽

10.3390/pharmacy8030132 ◽

2020 ◽

Vol 8 (3) ◽

pp. 132

Author(s):

Jordan Spillane ◽

Erika Smith

Keyword(s):

Primary Care ◽

Case Report ◽

Health System ◽

Financial Models ◽

Lessons Learned ◽

Medical Team ◽

Ambulatory Clinic ◽

Published Evidence ◽

Pharmacist Services ◽

Team Model

This case report details the five year journey of implementing, growing and optimizing a primary care pharmacist model in the ambulatory clinic setting within a health system. There is published evidence supporting the numerous benefits of including pharmacists in the primary care medical team model. This case report provides information regarding evolution of practice, the pharmacists’ roles, justification and financial models for the pharmacist services, as well as lessons learned and determined conclusions.

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Primary Care Provider Perceptions of Pharmacist Services in an Urban, Safety Net Health System

Journal of Pharmacy Practice ◽

10.1177/0897190019838422 ◽

2019 ◽

Vol 33 (6) ◽

pp. 790-798

Author(s):

Anusha McNamara ◽

Lenny L. S. Chan ◽

Shirley L. Wong

Keyword(s):

Primary Care ◽

Patient Care ◽

Medication Management ◽

Primary Care Providers ◽

Safety Net ◽

Direct Patient Care ◽

Case Conference ◽

Pharmacy Services ◽

Care Providers ◽

Pharmacist Services

While pharmacists have provided services in a multidisciplinary, primary care setting for decades, few publications have yet to evaluate providers’ impressions of- these services. An anonymous 14-item survey distributed to nonresident primary care providers aimed to identify clinical pharmacist services that are most and least helpful to primary care providers, identify barriers to pharmacy services, and develop recommendations to improve pharmacy services in primary care. The most important pharmacist contribution identified by providers is medication management, whereas the least important contributions are case conference, panel management, quality improvement, and transition of care. The primary reasons for referrals to pharmacists included inadequately controlled chronic diseases, poor or questionable adherence, longer visits for more in-depth discussion, and complex regimen requiring frequent monitoring or titration. Providers favored pharmacists working in direct patient care versus indirect patient care activities. Although many providers perceived no barriers to pharmacist service access, pharmacists’ presence and visibility were 2 barriers identified. Most providers preferred comprehensive to disease-specific medication management.

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Primary Care Pharmacist Services Align With Payment Reform and Provider “Joy of Practice”

Annals of Pharmacotherapy ◽

10.1177/1060028018807398 ◽

2018 ◽

Vol 53 (3) ◽

pp. 311-315 ◽

Cited By ~ 3

Author(s):

Marie Smith

Keyword(s):

Primary Care ◽

Organizational Leaders ◽

Payment Reform ◽

Policy Makers ◽

Payment Mechanism ◽

Pharmacist Services ◽

Medication Optimization ◽

Payment Models ◽

Management Services

The implementation and expansion of primary care (PC) pharmacist medication optimization and management services has been hindered mainly by the lack of a payment mechanism for PC providers to engage pharmacist services. If pharmacists expect to be included in new PC team-based payment models, we need to actively engage in ongoing PC practice transformation discussions with PC organizational leaders. In this commentary, examples of integrated PC pharmacist services and payment models are provided to (1) reinforce the feasibility of pharmacist integration into expanded PC teams and (2) share with PC leaders, payers, and policy makers.

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