CHICAGO—Could the addition of a pharmacist to rheumatology care teams improve patient satisfaction, decrease staff burnout or reduce medication-related problems? Three panelists in Integrating Pharmacists into the Workforce, a session at the 2018 ACR/ARHP Annual Meeting, shared positive experiences with this interdisciplinary care model.
Less Burnout, More Satisfaction
Ten years ago, the Arthritis Treatment Center at Tufts Medical Center, Boston, added a clinical pharmacist to its interdisciplinary team two days a week, said William F. Harvey, MD, MSc, the center’s clinical director.
“At that time, there was a rapid increase in the number of complex therapies being administered,” including biologic and biosimilar therapies that required more administrative oversight from his small staff, Dr. Harvey said. “Also, there were changes in insurance requirements. I think we do more paperwork for insurance coverage than we do for anything else in the course of our care.”
Electronic medical records (EMRs) and reimbursement reporting took more staff time away from patient consultations. This contributed to staff burnout and high turnover, increased patient wait times and decreased patient satisfaction, said Dr. Harvey. “We were taking a big hit. It’s easy to feel assaulted by all this technology.”
In the first year, the clinic’s pharmacist focused on point-of-care benefit analyses and prior authorizations for outpatient biologics filled by Tufts’ 340b specialty pharmacy. “Our patients loved our pharmacist. They treated the pharmacist like a member of the team,” said Dr. Harvey, noting patients frequently spoke to the pharmacist more often than to their providers.
The clinic’s model for covering the cost of adding a pharmacist included increasing revenue for its specialty pharmacy, and in just the first year, the clinic found revenue rose slightly. Revenue grew substantially over the next 10 years to make the arrangement cost effective, he said.
‘The pharmacist’s scope of work increased tremendously, & the impact on our practice was profound.’ —Dr. Harvey
Five years into the arrangement, the clinic increased its pharmacist’s responsibilities to include obtaining all prior authorizations, conducting patient education and follow-ups regarding medications, talking with patients about manufacturers’ assistance programs, working rounds in the infusion center, performing medication reconciliations for complex patients and providing injection training.
“The pharmacist’s scope of work increased tremendously, and the impact on our practice was profound,” Dr. Harvey said. The clinic is also able to leverage a pharmacy technician’s time along with other departments at the hospital. “It has completely transformed the operations of our clinic.”
In a typical day in clinic, Dr. Harvey said he may meet with a new patient to review the treatment pathway, then call in the pharmacist to “go over anything the patient will need to know about the medication, and I focus my conversation on their prognosis, the natural history of the disease, what to expect,” he said. “Our pharmacist might teach patients how to do their injections, or if patients are afraid to do their own injections, she arranges for them to come back so we can do this in the office.” The pharmacist consults with patients about the cheapest therapies under their insurance plan and alerts providers when patients have drug side effects, he added.
When Dr. Harvey and his staff analyzed data collected for standardized reporting purposes, “we noticed our provider rating going up,” he said. “Why would our provider rating go up when we started turning over half the conversation about a patient’s medications to the pharmacist? Patients really respond to having an accessible team for their care.” Patient referrals, staff quality measures and provider satisfaction rose after the clinic added a pharmacist. “There were also increases in our scores for culture of safety. We felt like we were taking better care of our patients.”
Did this new concept reduce staff burnout? Although this is hard to measure, Dr. Harvey cited the Quadruple Aim, a model for high-functioning clinics that includes improving patients’ health, experience of care and per capita cost of care, as well as providers taking joy in practice.1 “How many people would love to come home from their day at clinic and say, ‘I had joy at work today?’” he said. With rising administrative burdens and healthcare costs, “It’s becoming increasingly difficult to feel that way. But what if you could do that?”
Adding a pharmacist helped the clinic achieve several Quadruple Aim measures, including adding capacity by sharing care among a team, saving time by re-engineering prescription refill work out of the practice and reducing unnecessary physician work with email management, said Dr. Harvey.2 “We are all a lot happier, have a lot more fun, and one of our providers said that bringing in the pharmacist is the best thing we’ve done in years.”