Improving clinic utilization and workload capture for clinical pharmacy specialists

Abstract

Purpose To assess a quality improvement initiative aimed at improving clinic utilization and encounter and intervention workload capture for clinical pharmacy specialists. This initiative aided in justification of clinical pharmacy services, identification of clinical areas for intervention, and incorporation of all modalities to appropriately document clinical care. Methods In order to objectively demonstrate clinical pharmacy service value to stakeholders, pharmacy administrators and clinical pharmacy specialists at the North Florida/South Georgia Veterans Health System performed clinic scheduling and profile reviews using data extracted from the Veterans Health Administration electronic health record and analytic software. Outpatient clinical pharmacy specialty practice areas were primarily investigated; the specialty areas included are as follows: cardiology, infectious disease, mental health, oncology, pain management/palliative care, and specialty clinics (a collection of medical and surgical subspecialties). The first intervention entailed completing a worksheet and assessing clinic utilization data. Then, an evaluation was performed to assess the number of encounters, clinical interventions, clinic modalities, and coding for each clinic. Next, a meeting was arranged with each like clinical pharmacy specialist practice group to discuss this collected data. During these meetings, the delineation of where workload was generated and the activities taking place in an average workday were discussed. Finally, clinics were adjusted to reflect appropriate clinic coding and mapping of the average workday. Metrics were evaluated pre intervention (October through December 2017) and post intervention (July through September 2018). Results After intervention, there were statistically significant increases in clinic utilization, total encounters completed, and total interventions recorded in the composite group of clinical pharmacy specialists. Conclusion The increases in clinic utilization, total encounters, and interventions observed for the clinical pharmacy specialists suggest the beneficial role of pharmacy administrators’ collaboration with clinical pharmacy specialists to improve workload capture and access to quality care, to justify clinical pharmacy services, and to identify opportunities for pharmacy clinical intervention.

Research on outpatient capacity planning combining lean thinking and integer linear programming

“…Compared with a single-phase system in which the physician performs all parts of the service, the results showed that the addition of MLSP reduced patient waiting time, patient flow time, and physician service time. Steen et al adjusted the location of workload generation and activities in working days, improving clinic utilization rate and a total number of visits in the clinical pharmacy expert compound group [ 35 ]. The implementation of the intervention shows that pharmaceutical administrators can improve workload and obtain quality care by cooperating with clinical pharmaceutical experts.…”

Identifying ideal pharmacist‐to‐patient ratios for the successful provision of clinical pharmacy services

“…However, estimating clinical pharmacist FTEs from provider panel size is challenging without considering the patient population and clinical pharmacist's direct patient care and non‐direct patient care responsibilities. Clinical pharmacist panel sizes need to be adjusted to account for the medical complexity of the patient population because of medication management needs, challenges encountered with social determinants of health, scope and intensity of ambulatory pharmacy services provided, and other activities factoring into pharmacist workload (i.e., administrative, scholarship, and teaching duties) 18,20,75,76 …”

“…Clinical pharmacist panel sizes need to be adjusted to account for the medical complexity of the patient population because of medication management needs, challenges encountered with social determinants of health, scope and intensity of ambulatory pharmacy services provided, and other activities factoring into pharmacist workload (i.e., administrative, scholarship, and teaching duties). 18,20,75,76 Patient panel size for a pharmacy service in the ambulatory care setting may initially be estimated using population health or hospital discharge statistics identifying patients who would benefit from clinical pharmacist-led services (e.g., those targeted at reducing heart failure readmissions or improving quality measures). As previously mentioned, the VHA model offers a strategy for making this estimation.…”