Evaluation of Services Provided by Pharmacists in Addition to Accredited Patient Management Program Responsibilities in a Health-System Specialty Pharmacy

Presenting Author: Jeremiah Moore, PharmD, BCOP, James P. Wilmot Cancer Institute, University of Rochester Specialty Pharmacy, Rochester, NY

Co-Authors: Maria Pinto, PharmD, University of Rochester Community Pharmacy, Rochester, NY; Elizabeth Rightmier, PharmD, BCPS, University of Rochester Specialty Pharmacy, Rochester, NY

BACKGROUND: Health-system specialty pharmacies struggle to maintain adequate staffing with continuous growth. New positions are typically justified by increased prescription volume; however, pharmacists are frequently tasked with providing services for patients not directly falling under responsibilities of their accredited patient management program. Guidance on services and time spent may be a valuable tool for health-system specialty pharmacies to consider in requesting additional support.

OBJECTIVE: To approximate the quantity and type of pharmacist actions related to patients fulfilling their specialty prescriptions at external pharmacies or nonspecialty medications.

METHODS: Single-center, prospective quality improvement study to evaluate pharmacy services requested for patients either not actively enrolled in a University of Rochester Specialty Pharmacy (URSP) patient management program or related to medications fulfilled externally. URSP is accredited by the Utilization Review Accreditation Commission and the Accreditation Commission for Healthcare. External was defined as any pharmacy other than URSP, which included ambulatory, infusion, or inpatient pharmacy sites within the health system. Standardized actions performed by clinical pharmacists employed by the specialty pharmacy and with integrated workflows in the nononcology (cardiology, dermatology, gastroenterology, hepatology, infectious diseases, neurology, primary care, rheumatology) and oncology clinics were documented in the electronic medical record between September 1, 2023, and November 30, 2023. The primary outcome was quantity of pharmacist actions requested to intervene with medication therapy problems or to answer drug information questions. Secondary outcomes included source of the request for pharmacy services, drug category (specialty, nonspecialty, infusion), status of enrollment in the patient management program, urgency of request, and approximate time spent. All analysis was descriptive.

RESULTS: Pharmacists performed 926 actions, documenting 775 encounters involving 630 unique patients. The majority of pharmacy service requests were from the oncology clinic (76.3%), followed by rheumatology (11.2%) and neurology (5%). Among oncology clinic, providers most requested pharmacy services (57.5%), specifically advanced practice providers (39.6%) and physicians (17.9%). Most actions were nonurgent, representing 68.9% for oncology and 84.8% for nononcology clinics. Actions were most frequently categorized as drug information (68.9%) followed by medication therapy problems (16.5%). The most common pharmacy service requests from oncology clinics involved nonspecialty medications (47.8%) and infusions (30.7%), whereas nononcology clinics primarily received requests related to specialty medications fulfilled externally (61.6%). Pharmacists spent <15 minutes (68.8%) and 15 to 30 minutes (24.1%) per patient on most encounters.

CONCLUSION: This study highlights the significant contributions that URSP provides to patients in addition to their responsibilities within the scope of their specialty pharmacy–accredited patient management programs and supports the request for additional pharmacist support.

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