Targeted Delivery of Clinical Pharmacy Services Using a Mixed Specialist and Generalist Pharmacy Practice Model
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Purpose: Due to a reduction in pharmacists, a mixed generalist-specialist pharmacy practice model with distinct responsibilities was implemented to better optimize pharmacist skills. This required temporary reduction in pharmacy staff in the emergency department (ED) to provide clinical pharmacy services elsewhere in the hospital. The purpose of this study was to assess process improvement measures (discharge counseling, documented interventions, and pharmacy scorecard review) and patient outcome differences (30-day readmission) before and after the practice model change in hospitalized, high-risk patients and the ED. Methods: A quasi-experimental quality improvement study was conducted in 2015 after a pharmacy practice staffing model change. Patients at high-need for clinical pharmacy services (defined as a LACE score ≥ 9) and patients admitted to the emergency department at a large academic medical center were evaluated for three months before and after the model change. Data collected included moderate-serious interventions, scorecard evaluation, discharge counseling documentation, and 30-day readmissions. Results: Nine hundred and sixty-one patients were evaluated before (n=449) or after (n=512) the model change. Among high-risk, non-ED patients, process improvements including discharge counseling and scorecard review increased significantly during the study period and were associated with a statistically significant decrease in readmission rates. In the ED, process improvements including moderate-serious interventions and discharge counseling decreased significantly after loss of clinical pharmacy services. Conclusion: A mixed pharmacy practice model targeting high-risk patients improved process improvement measures and patient outcomes. Reduction in clinical pharmacy services in the ED affected process improvement measures in this area of the hospital.