Background
During the COVID19 pandemic, physician focus shifted from continuity of care to pandemic duties. However, patients still required in-person visits for acute or chronic complaints. Specially trained pharmacists were utilized to alleviate Family Medicine Walk-in (FMWI) provider shortages.
Objective
To describe the innovative practice utilizing diagnostic pharmacists in FMWI, evaluate their impact on provider time, compare workload to traditional advanced practice providers (APP), and evaluate type of visits and medications prescribed.
Practice Description
Pharmacists at an Indian Health Service medical center staffed FMWI 2.5 days per week to alleviate provider shortages during the COVID19 pandemic. The privileged pharmacist had a diagnostic scope like APPs. Non-privileged pharmacists provided care to patients utilizing current protocols and were required to present all new complaints to providers.
Practice Innovation
The facility utilized pharmacists that have completed, or progressing through, the local diagnostic training program to alleviate provider shortages.
Evaluation Methods
The absolute number of visits by pharmacists was determined and the number of provider hours shifted to pharmacy estimated. The number of visits by provider type was calculated and compared. ICD-10 codes were evaluated for purpose of visits. New prescriptions written by pharmacists were categorized and reimbursement rates determined.
Results
Pharmacists were responsible for 677 visits during 88 clinic days with an estimated 338 provider hours shifted to pharmacists. Pharmacists saw 5.8 patients per day, APPs 5.2, and physicians 5.7. Pharmacists primarily evaluated hypertension, diabetes, musculoskeletal, and infectious disease complaints. New prescription categories included pain management, endocrine, cardiovascular, and infectious disease. The single billable pharmacist was reimbursed $77,945.
Conclusion
Diagnostic pharmacists in FMWI have allowed providers to shift to other pandemic duties and demonstrate similar workload as APPs. Most visits and prescriptions fall within known pharmacist practice. Pharmacists in this setting pay for the existence of this position and remain integrated in FMWI.