Outcomes of a pharmacist-managed medication refill program

Billups, Sarah J.; Delate, Thomas; Newlon, Carey L.; Schwiesow, Sarah; Jahnke, Renee; Nadrash, Ann

doi:10.1331/japha.2013.13008

Cited by 14 publications

(11 citation statements)

References 8 publications

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“… 43 A community pharmacy with access to a patient’s electronic medical record was able to evaluate laboratory measures and order tests if needed, ultimately reducing the number of medication refills requested that lacked necessary monitoring and improved patient satisfaction related to prescriptions being ready in a timely manner. 44 Similarly, two Dutch studies looked at adherence for various types of medications and utilized electronic health records to determine whether patients should be contacted about refilling their prescriptions, as part of a larger patient-centered intervention with patients being highly satisfied with the change and indicating that the pharmacy was the only place where they had received information related to medication effectiveness. 45 , 46 Taking patient care a step further, one study found that use of a phone call to follow up on antibiotic use is effective in identifying drug-related problems, but it was not found to improve symptoms patients experienced or patient satisfaction.…”

Section: Types Of Servicesmentioning

confidence: 99%

Review of community pharmacy services: what is being performed, and where are the opportunities for improvement?

Melton¹,

Lai²

2017

IPRP

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ObjectiveThe aim of this review was to assess pharmacist and pharmacy services being provided and identify opportunities to improve patient satisfaction.MethodsStudies published between January 2006 and July 2016 examining patient satisfaction with pharmacy and pharmacist services, which were written in English, were identified in PubMed. Studies were excluded if they only looked at pharmacy student-provided services.Key findingsA total of 50 studies were ultimately included in the review. Of these studies, 28 examined services traditionally provided by community pharmacists such as dispensing and counseling, while 16 examined a new in-person service being offered by a pharmacy, and the remaining six involved a new technology-assisted service. While study findings were generally positive for patient satisfaction of pharmacy services, several opportunities were identified for pharmacies to improve.ConclusionOverall, patient satisfaction is high across pharmacy services; however, this satisfaction is related to prior patient exposure to services and their level of expectation. Pharmacists have multiple opportunities to improve the services they provide, and there are additional services pharmacists may consider offering to expand their role within the health care system.

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Section: Types Of Servicesmentioning

confidence: 99%

Review of community pharmacy services: what is being performed, and where are the opportunities for improvement?

Melton¹,

Lai²

2017

IPRP

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“…In contrast, some organizations manage prescription renewals centrally, for example, by pharmacy. 4,12,13 Rim et al described a centralized renewal authorization program within an academic health system with two pharmacists and two pharmacy technicians. 4 The program consisted of a collaborative practice agreement that authorized the pharmacists to approve the prescription renewal requests.…”

Section: Discussionmentioning

confidence: 99%

Rebuilding the Standing Prescription Renewal Orders

et al. 2019

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Background Managing prescription renewal requests is a labor-intensive challenge in ambulatory care. In 2009, Vanderbilt University Medical Center developed clinic-specific standing prescription renewal orders that allowed nurses, under specific conditions, to authorize renewal requests. Formulary and authorization changes made maintaining these documents very challenging. Objective This article aims to review, standardize, and restructure legacy standing prescription renewal orders into a modular, scalable, and easier to manage format for conversion and use in a new electronic health record (EHR). Methods We created an enterprise-wide renewal domain model using modular subgroups within the main institutional standing renewal order policy by extracting metadata, medication group names, medication ingredient names, and renewal criteria from approved legacy standing renewal orders. Instance-based matching compared medication groups in a pairwise manner to calculate a similarity score between medication groups. We grouped and standardized medication groups with high similarity by mapping them to medication classes from a medication terminology vendor and filtering them by intended route (e.g., oral, subcutaneous, inhalation). After standardizing the renewal criteria to a short list of reusable criteria, the Pharmacy and Therapeutics (P&T) committee reviewed and approved candidate medication groups and corresponding renewal criteria. Results Seventy-eight legacy standing prescription renewal orders covered 135 clinics (some applied to multiple clinics). Several standing orders were perfectly congruent, listing identical medications for renewal. We consolidated 870 distinct medication classes to 164 subgroups and assigned renewal criteria. We consolidated 379 distinct legacy renewal criteria to 21 criteria. After approval by the P&T committee, we built subgroups in a structured and consistent format in the new EHR, where they facilitated chart review and standing order adherence by nurses. Additionally, clinicians could search an autogenerated document of the standing order content from the EHR data warehouse. Conclusion We describe a methodology for standardizing and scaling standing prescription renewal orders at an enterprise level while transitioning to a new EHR.

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“…In a previous comparator study, there were higher rates of medication laboratory monitoring and clinician visits (64% vs 58%, P < .001) with a pharmacist-managed refill program when compared with usual care. 6 The PMAC model included a more expansive scope of medications and experienced higher rates of medication monitoring when compared with usual care. Unlike previous literature, our study compared the rates of drug therapy problems that resulted in a therapy change and made a distinction between interventions and recommendations that allowed us to report provider acceptance rates.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 Current evidence supports the use of collaborative practice agreements between physicians and pharmacists to relieve physician refill request burden. [6][7][8][9] By pharmacists renewing medication requests, a physician can save an estimate of 2.5 hours a week. 7,8 This allows more time for direct patient care and improves physician satisfaction.…”

Section: Introductionmentioning

confidence: 99%

“…7,8 This allows more time for direct patient care and improves physician satisfaction. [6][7][8] Additionally, pharmacists were able to decrease the refill request turnaround time by 1 to 2 days, resulting in increased patient satisfaction as more patients' prescriptions were available when they arrived at the pharmacy. 6,7,9 Furthermore, pharmacists' extensive training in pharmacology make them uniquely suited to provide individualized medication therapy management and safety monitoring resulting in a reduction of adverse events and better patientcentered outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Interventions Made in an Ambulatory Pharmacist-Managed Refill Model to Usual Physician Care

Okraszewski

Sattler-Leja

Brodman

et al. 2019

Journal of Pharmacy Technology

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Background: With the current practice model, there is less time for physicians to address refill authorization requests (RARs) while performing consistent quality care, which creates an opportunity for pharmacists to assist in refills. Currently, inadequate evidence is available to support this intervention. Objective: To compare the rate of medication management interventions (MMIs - drug therapy changes, laboratory monitoring ordered, or office visit scheduled) initiated by the pharmacist-managed authorization center (PMAC) to usual care. Methods: A retrospective, noninferiority study looked at 4000 RARs from 6 primary care centers from January 2016 through March 2017. The primary endpoint compared the rate of MMIs between PMAC and usual care. Noninferiority was concluded if the upper limit of the 95% CI of the difference in interventions was <2%. Secondary endpoints included total, type, and acceptance rate of PMAC recommendations. Results: A total of 3830 patients were included, with 4732 medications requested (2183 reviewed by PMAC and 2549 by usual care). MMIs occurred in 153 medications within PMAC (7.0%) versus 90 for usual care (3.5%). The difference in total MMIs between PMAC and usual care was −3.5% (95% confidence interval = −4.8% to −2.2%). Medications reviewed by PMAC had significantly higher number of laboratory monitoring ( P = .036) and scheduled appointments ( P < .001). There were 294 PMAC recommendations (13.5%) with a 52.0% acceptance rate. Conclusion and Relevance: This study showed that PMAC was superior to usual care for reviewing RARs. There was a statistically significant improvement in medication monitoring and patient follow-up, supporting the idea of including a pharmacist in the decision making.

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Outcomes of a pharmacist-managed medication refill program

Cited by 14 publications

References 8 publications

Review of community pharmacy services: what is being performed, and where are the opportunities for improvement?

Review of community pharmacy services: what is being performed, and where are the opportunities for improvement?

Rebuilding the Standing Prescription Renewal Orders

Comparison of Interventions Made in an Ambulatory Pharmacist-Managed Refill Model to Usual Physician Care

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