Medication Outcomes Improve Via Clinical Pharmacy Priority Score

Ranking patients based on clinical pharmacy priority scoring can improve both medication outcomes and pharmacist-physician relationships.

Joseph P. Vande Griend, PharmD, BCPS, CGP, and his colleagues designed an algorithm to examine 11 patient-specific factors extracted from the electronic health record in order to determine the effects of clinical pharmacy priority scoring.

The investigators performed comprehensive medication reviews (CMRs) for 1107 patients with appointments with a clinical pharmacist between October 2012 and December 2012 across 2 University of Colorado family medicine clinics.

“The concept was patients come in with appointments, and some of them have 1 to 2 medications and don’t need much further review because they’re fairly simple, but others have really complicated diseases, a lot of medications, or patients who are older,” Dr. Griend told Pharmacy Times. “It became really clear the need to define my population and who I would look at. It would make me a lot more efficient and effective.”

Around 100 patients were identified as having received a medication recommendation from the clinical pharmacist. In total, the clinical pharmacist made 223 medication recommendations for 101 patient appointments, and almost 60% were accepted and implemented by patients’ physicians.

The majority of the patients in this group had hypertension (84%), followed by diabetes (48%), vascular disease (26%), depression (22%), and chronic obstructive pulmonary disease (COPD) (8%). Heart failure was present in 5% of patients examined.

Patients with higher clinical pharmacy priority scores were more likely to have diabetes or hypertension, 6 or more medications on their list, and blood pressure >140/90 mm Hg, the researchers noted. They were also more likely to receive a medication recommendation after CMR by a clinical pharmacist than patients with lower scores.

Based on these findings, the researchers concluded that clinical pharmacy priority scoring “could be used by clinical pharmacists in family medicine to enhance the efficient and effective delivery of interprofessional care.”

Before the implementation of this scoring system, it took approximately 6 hours to review an entire weekly patient appointment list consisting of about 100 patients and provide CMR for selected patients. After implementation, weekly hours needed for this process were reduced to 1.5 hours.

“The health care system really needed to find a way to see how you could take that expensive resource and make it as efficient as possible. You really target those folks who you want to see the most and the ones that you’re going to have the most impact on,” Dr. Griend said. “That’s what health care is really going to move toward, and it is already. How can we take the limited resources we have and target those to specific patients?”

Dr. Griend further explained that the physician-pharmacist relationship also improved throughout the study’s observation period.

“The pharmacist can say, ‘Hey, your patient has a lot going on with their medications. I should really make a recommendation or take a look at where we can improve things,’” he explained.

These findings were published in the Journal of the American Board of Family Medicine.