Effectiveness of Clinical Pharmacy Services to Be Tested

The USC School of Pharmacy has received a grant to provide clinical pharmacy services in safety-net clinics and compare outcomes and costs with control clinics.

Clinical pharmacy teams will be embedded in 3 Southern California safety-net clinics later this summer as part of a project to test the ability of improved medication therapy to better health outcomes while reducing overall medical costs. The project will be run by researchers at the USC School of Pharmacy and funded by a $12 million grant from the Center for Medicare and Medicaid Services. The researchers estimate that the project will save $43 million over 3 years.

Each of the 3 participating Orange County clinics, all run by AltaMed Health Services, will be served by a clinical pharmacy team consisting of 2 pharmacists, 2 pharmacy residents, and 2 pharmacy technicians. The project aims to provide treatment for 9000 patients by the end of its first year. Patients at the clinics are majority Hispanic and low income and have high rates of chronic conditions such as diabetes, hypertension, and dyslipidemia that benefit from proper medication therapy. The researchers will monitor health care quality, medication safety, and overall health care cost at the 3 intervention clinics as well as 3 comparable clinics that will not receive clinical pharmacy services.

“We estimate we can save about 12% to 15% on medical care expenditures within the first year,” says Geoffrey Joyce, PhD, the project’s principal investigator and an associate professor at the USC School of Pharmacy. “Because these are high-risk patients who show up a lot in in-patient settings, averting some hospitalizations and some ER use pays for itself very quickly.”

The pharmacy teams will aim to provide medication reconciliation services for all patients at the clinics and use a variety of criteria to identify patients who will benefit most from intensive medication therapy. Among these will include patients who go to emergency rooms and hospitals most frequently; patients in transitions of care; patients with the highest overall health care costs; and patients who fail to fill their prescriptions or appear to be at risk of medication-related harm based on other data gathered by AltaMed.

“We are managing the highest-risk patients and also trying to prevent other patients from moving into that high-risk category,” says Steven Chen, PharmD, a co-investigator on the project and an associate professor at the USC School of Pharmacy.

The project's team members will be drawn primarily from pharmacists who have gone through or are currently participating in the safety-net residency program at the USC School of Pharmacy. This will ensure that the pharmacists have the skills necessary to work with the underserved patient population found in the participating clinics. Pharmacy technicians on the project teams will also play a significantly expanded role; rather than working in a dispensary, they will maintain contact with patients to ensure they are taking medication properly and make follow-up appointments. Ultimately, the researchers hope to demonstrate that clinical pharmacists are key members of the health care team.

“The problem is [clinical pharmacy management] is seen as a value-added service or something extra that could be helpful, whereas in reality we have shown that this is an essential service,” says Dr. Chen. “Every patient should have access to a clinical pharmacist because there really isn’t another member of the health care team that has the training and expertise to focus exclusively on maximizing medication-related outcomes and improving medication safety.”

In the project’s second year, it will expand to 2 additional safety-net clinics in Los Angeles. The project will also include development of a tele-pharmacy service in which clinical pharmacists can consult with patients via 2-way video to clinics that are not large enough to hire a full-time clinical pharmacist. Another co-investigator will work on a Web-based training and credentialing program to help other pharmacists develop the skills necessary to launch similar programs in clinics across the country.