Pharmacist value-added to neuro-oncology subspecialty clinics: A pilot study uncovers opportunities for best practices and optimal time utilization

Abstract

Purpose To evaluate neuro-oncology clinician time utilization for medication management and identify a cost beneficial role for integration of a dedicated pharmacy specialists. Methods A pharmacist was temporarily integrated into a neuro-oncology clinic for a 30-day period to evaluate the clinical practice and perform a 14-day clinical chart evaluation and patient interactions as part of a single institutional exploratory analysis. The pharmacist completed screenings for drug-drug interactions, new therapies, medication reconciliation, and advanced interventions as part of a collaborative practice agreement for pharmacist autonomy. Pharmacist time spent was calculated and documented within the patient encounters to support physician decision-making. A comparative estimate of pharmacist versus physician time utilization and cost for each was completed to derive a savings analysis for integration of a dedicated clinic pharmacist. Result During the 14-day clinical assessment, the pharmacist completed 147 encounters with 338 interventions. Of the encounters, 90% (n = 132) were higher complexity requiring plan modification, and approximately 48% (n = 162) of all interventions required ≥10 minutes of the pharmacist’s time. Physician non-patient-facing time devoted to medication tasks was 5-hours weekly (0.125 FTE, full time equivalents), an estimated direct salary cost of $937/week ($45,000 yearly). Hire of a part-time pharmacist at 0.50 FTE would cover the clinical need with supported documentation and medication monitoring at a cost of $45,000/year. Conclusion Defining the roles for dedicated neuro-oncology clinic pharmacists allows for cost-savings through re-allocation of physician time and improves subspecialty clinic operations as well as patient care.

Expanding oncology pharmacist teams: Justifying the return on investment

“…This time equated to 0.4-0.5 pharmacist FTE (0.125 physician FTE) and additional physician patient-facing-encounters to improve access to care and increase revenue potential. 28 Another site recently described a service expansion project for anticoagulation management of oncology patients and demonstrated an estimated 325 h' time saved and a predicted $93,000 cost avoidance to the clinic staff when a pharmacist managed the anticoagulation. The organization also found that quality of care improved demonstrated by the International Normalized Ratio (INR) in goal range in 83% of patients monitored by pharmacists compared to 68% if not managed by a pharmacist 29 Lastly, ambulatory clinic areas present opportunities for direct revenue generation by billing for pharmacist services.…”