PHarmacist Avoidance or Reductions in Medical Costs in CRITically Ill Adults: PHARM-CRIT Study

Abstract

OBJECTIVES: To comprehensively classify interventions performed by ICU clinical pharmacists and quantify cost avoidance generated through their accepted interventions. DESIGN: A multicenter, prospective, observational study was performed between August 2018 and January 2019. SETTING: Community hospitals and academic medical centers in the United States. PARTICIPANTS: ICU clinical pharmacists. INTERVENTIONS: Recommendations classified into one of 38 intervention categories (divided into six unique sections) associated with cost avoidance. MEASUREMENTS AND MAIN RESULTS: Two-hundred fifteen ICU pharmacists at 85 centers performed 55,926 interventions during 3,148 shifts that were accepted on 27,681 adult patient days and generated $23,404,089 of cost avoidance. The quantity of accepted interventions and cost avoidance generated in six established sections was adverse drug event prevention (5,777 interventions; $5,822,539 CA), resource utilization (12,630 interventions; $4,491,318), individualization of patient care (29,284 interventions; $9,680,036 cost avoidance), prophylaxis (1,639 interventions; $1,414,465 cost avoidance), hands-on care (1,828 interventions; $1,339,621 cost avoidance), and administrative/supportive tasks (4,768 interventions; $656,110 cost avoidance). Mean cost avoidance was $418 per intervention, $845 per patient day, and $7,435 per ICU pharmacist shift. The annualized cost avoidance from an ICU pharmacist is $1,784,302. The potential monetary cost avoidance to pharmacist salary ratio was between $3.3:1 and $9.6:1. CONCLUSIONS: Pharmacist involvement in the care of critically ill patients results in significant avoidance of healthcare costs, particularly in the areas of individualization of patient care, adverse drug event prevention, and resource utilization. The potential monetary cost avoidance to pharmacist salary ratio employing an ICU clinical pharmacist is between $3.3:1 and $9.6:1.

Premature attrition of clinical pharmacists: Call to attention, action, and potential solutions

“…While research demonstrating the benefit of clinical pharmacy services has been conducted for decades, the problem remains that health care is driven by revenue generation. The presence of clinical pharmacists undoubtedly leads to a high level of cost avoidance 3,6,20 . However, this does little to generate actual revenue, as clinical pharmacy services are not typically reimbursable.…”

“…In contrast, clinical pharmacists are typically responsible for the care of entire units or medical services and have fewer opportunities to secure protected time and clinical career advancement. Indeed, a recent study of intensive care unit pharmacists demonstrated that nearly a third of participants covered at least two services, corresponding to a median of 21 patients (compared with 13 patients for those covering one service) 3 . Beyond bedside care, clinical pharmacist responsibilities can include the following: both prospective and retrospective order verification, precepting trainees (eg, pharmacy residents and students), hospital or clinic committee participation, research and scholarship, and involvement in national and local organization leadership, guideline, protocol, and medication use processes development, among other unit and pharmacist‐specific roles 4 .…”

“…Although multiple studies have demonstrated the benefit of clinical pharmacists, little exists describing the typical “lifespan” of this group 3,6 . Many clinical pharmacists are reporting high rates of burnout, with variable systematic barriers and contributing factors at play 9 .…”

“…Indeed, a recent study of intensive care unit pharmacists demonstrated that nearly a third of participants covered at least two services, corresponding to a median of 21 patients (compared with 13 patients for those covering one service). 3 Beyond bedside care, clinical pharmacist responsibilities can include the following: both prospective and retrospective order verification, precepting trainees (eg, pharmacy residents and students), hospital or clinic committee participation, research and scholarship, and involvement in national and local organization leadership, guideline, protocol, and medication use processes development, among other unit and pharmacist-specific roles. 4 These activities translate in to numerous benefits, including optimization of medications, decreased medication errors, improved patient outcomes, and significant cost avoidance.…”

“…[5][6][7][8] Although multiple studies have demonstrated the benefit of clinical pharmacists, little exists describing the typical "lifespan" of this group. 3,6 Many clinical pharmacists are reporting high rates of burnout, with variable systematic barriers and contributing factors at play. 9 Anecdotally, we have observed a trend of clinical pharmacists leaving practice to pursue careers removed from patient care that favor worklife balance.…”