The Invaluable Role a Clinical Pharmacist Brings to an Ambulatory Care Setting

Ambulatory pharmacy represents a critical, yet sometimes overlooked, aspect of patient care. When a patient is prescribed a specialty medication, the pathway to getting that medication is often marked with many obstacles. An ambulatory pharmacist’s role is to help patients navigate this path and ensure they are getting the care they need.¹

In the ambulatory pharmacy setting, the pharmacist becomes part of the care team within a hospital or health system, working directly with a patient’s providers and staff to improve access to care and personalized support. They provide comprehensive medication management to patients across all health care settings, including in direct patient care environments.¹ Spanning a wide range of services beyond medication counseling, clinical pharmacy intervention by ambulatory pharmacists can include ordering and interpreting lab values to assess medication efficacy, initiation, adjustment, and/or discontinuation, as well as assessment of drug-drug interactions, referral to disease education, nutrition, social work and other social services. Further, ambulatory pharmacists can provide patient education on medications, diet, lifestyle, and devices such as glucometers.

Ambulatory pharmacists can provide patient education on medications, diet, lifestyle, and devices such as glucometers. Image Credit: Adobe Stock - natali_mis

Ambulatory pharmacists significantly improve patient outcomes by proactively assessing and eliminating barriers, streamlining medication delivery and ensuring patients stay adherent to their medication regimens. However, health systems can experience challenges when implementing models that acknowledge the extensive role clinical pharmacists play on the care team when they attempt to expand the boundaries of the established role. One of the main challenges involves defining the pharmacist’s role within clinic. While ambulatory practice is an increasingly expanding field within pharmacy, each clinic remains unique; physicians and advanced practice practitioners may have a limited understanding of the scope of each clinic’s practice and the value a clinical pharmacist can provide. Therefore, it is important to communicate to physicians, other providers, and staff the current workflow within the clinic and gaps that may exist in a practice. By facilitating open communication, it becomes possible to ensure a productive working relationship among all care team members moving forward.²

Payors can also vary widely in their reimbursement structure for pharmacist-based visits, and pharmacist’s visits on the same day as a physician’s visit are likely non-reimbursable. To properly implement a model where pharmacists bill for their services, there must be an appropriate workflow, revenue cycle integration, and documentation of services provided. While these represent challenges, the ability to overcome these barriers is not insurmountable and the benefit is substantial for the patients and care teams.

When considering implementation of an ambulatory clinical pharmacy program at a health system, it is important to evaluate the value added to the financial, clinical, operational, and patient experience. For example, it has been estimated that by practicing patient-centered care, pharmacists can increase the number of patients who receive optimal outcomes by 41%, reducing the cost of drug-related illness by almost 60%, and contributing to almost 120,000 lives saved per year.³

Clearway Health, a specialty pharmacy accelerator owned by Boston Medical Center, performed an evaluation with a regional community-based health system to project the impact of clinical pharmacy services. The analysis identified a patient population with uncontrolled diabetes, as measured by Hemoglobin A1C greater than 10. Of these patients, 38% were only seen by their provider twice per year, which is far from an ideal frequency to instill meaningful change for patients with uncontrolled diabetes.

In an early intervention workflow, the clinical pharmacist serves as an extension of the provider care team, with an ability to see patients more frequently (up to every 6 weeks). This increases engagement in patient care, optimizes therapy, and demonstrates improvements in medication adherence, ultimately improving outcomes for Type 2 diabetes. In addition, the pharmacist visits would qualify as a billable service, generating additional revenue for the system and mitigating the cost of a pharmacist salary. In this way, it cannot be underestimated the value that a clinical pharmacist can bring in an ambulatory care setting.

About the Author

Geri Buderwitz, PharmD, MBA, is the senior director of strategy at Clearway Health.

References

1. The American College of Clinical Pharmacy (ACCP). Standards of Practice for Clinical Pharmacist. ACCP website. March 2014. Accessed June 29, 2023. standardsofpractice.pdf (accp.com)
2. Ponushis, A. New tools connect physicians and pharmacists to build stronger collaborative relationships. American Association of Colleges of Pharmacy (AACP). October 1, 2018. Accessed June 29, 2023. https://www.aacp.org/article/embedding-pharmacists-physicians
3. Parrish RH, Chew L. Lecture 1—Justification of the Value of Clinical Pharmacy Services and Clinical Indicators Measurements—Introductory Remarks from a Traveler on a 40-Year Wayfaring Journey with Clinical Pharmacy and Pharmaceutical Care. Pharmacy (Basel). 2018;6(3):56. Published 2018 Jun 27. doi:10.3390/pharmacy6030056