Impact of Pharmacist Interventions on Patient Outcomes

Pharmacist-led interventions, as demonstrated in previous studies, were associated with improved adherence, medication utilization, and identification of drug related problems. Health system integrated specialty pharmacists are uniquely positioned to identify and address numerous complex clinical interventions in a timely and streamlined manner because of their access to the patient’s electronic health record, close connection to providers in clinic, and relationship formed between them and the patient. These pharmacist-led interventions improve patient care and satisfaction, while also improving overall costs for the healthcare system.

This multi-center, retrospective study examined the types of interventions completed by health system integrated specialty pharmacists and their impact and patient outcomes across a variety of disease states. The primary objectives were to identify and quantify the types of interventions being completed by health system integrated specialty pharmacists and demonstrate their resultant impact on clinical outcomes and overall cost. Intervention categories include adherence, adverse drug reaction (ADR), drug utilization review (DUR),lab recommendation, regimen recommendation, referral of service/linkage to care, and an “other clinical” category. Each type of intervention was assessed, along with its corresponding recommendation and outcome.

Results: 6,217 interventions were reviewed and broken into types. The three intervention types that pharmacists most frequently completed were adherence counseling/aid 34.69% (n=2157), regimen changes23.6% (n=1467), and ADR identification 21.62% (n=1344).Other interventions included lab recommendations 15.44% (n=960), DUR’s 2.61% (n=162), referral to services/linkage to care1.96% (n=127).Pharmacist identified adherence issues resulted in 541 (25.08%) drug/disease education recommendations, 332 (15.39%) adherence aids, 274 (12.7%) lifestyle recommendations, with the remaining 46.83% resulting in prescriber coordinations, follow-ups, and technology recommendations. Pharmacist identified regimen interventions resulted in257 (17.52%) therapy changes, 167 (11.38%) dose changes, 150 (10.23%) therapy continuations, with the remaining 60.87% resulting in frequency changes, schedule changes, lab draw coordination’s, office visits, additional therapies, and holding doses. Pharmacist identified ADR’s resulted in 607 (45.16%) mitigation strategy counseling, 194 (14..3%) OTC recommendations, 130 (9.67%) Rx recommendations, with the remaining 30.87% resulting in dose reductions, medication discontinuation, office visit recommendations, holding doses, and the side effect being unlikely caused by specialty medication.

Conclusion: Pharmacist interventions are vital to improving patient outcomes as well as improving costs to the healthcare system. Health system integrated specialty pharmacists are uniquely positioned to identify and address many complex clinical interventions in a timely and streamlined manner due to access to the patient’s electronic health record, close connection to providers in clinic, and relationship formed between them and the patient. This study identified the types of interventions completed by health system specialty pharmacists, and impact on patient outcomes. These interventions resulted in various accepted recommendations including drug/disease education, therapy changes, and counseling on mitigation strategies.