Quantifying the clinical interventions of pharmacists in specialty pharmacies in pediatric outpatient settings | Image credit: © Jacob Lund – © Jacob Lund – stock.adobe.com.
Takeaways
- Pharmacists at a pediatric health system specialty pharmacy (HSSP) made a significant financial impact through their clinical interventions.
- A retrospective study from Children’s Health of Orange County (CHOC) SP showed 238 clinical interventions, leading to a potential savings of $476,062.
- Clinical interventions covered a variety of conditions including cystic fibrosis, inflammatory bowel disease, rheumatology and growth hormone disorders.
- Drug interactions, care coordination, and adverse drug reactions were key areas contributing to cost avoidance.
- Study data can be used to promote the expansion of pharmacy services and in contract negotiations between health system administrators and health plans.
In a retrospective, single-center cohort study, results demonstrated that pharmacists in a pediatric health system specialty pharmacy (HSSP) performed clinical interventions beyond daily activities, resulting in a significant financial impact.
According to a poster abstract presented at the Health System Pharmacists’ Mid-Year Clinical Meeting and Exhibition held in Anaheim, California, from December 3, 2023 to December 7, 2023, SP services were used for a variety of conditions reported in adult populations. .
In a single-center retrospective cohort study conducted between January and December 2022, Children’s Health of Orange County (CHOC) MS patients were surveyed to quantify pharmacist clinical interventions and report cost avoidance associated with MS.
Secondary study outcomes included severity classification and prevention of adverse drug events (ADEs), as well as pharmacist time estimation.
CHOC SP is an integrated pediatric HSSP serving patients with cystic fibrosis (CF), inflammatory bowel disease (IBD), rheumatology and inflammatory disease (RIC), and growth hormone disorders (GH). ).
Patients who were followed by providers at CHOC specialty medical clinics or those who opted for CHOC SP services for disease management were inclusion criteria. Data collected were sex, age, therapeutic category, health status, specialized medications, pharmacist intervention, progress notes and duration of intervention.
According to the study, types of interventions (drug interactions, drug not indicated, adverse drug reactions, drug allergy) were consistently assigned a cost avoidance impact based on current literature.
The Common Terminology Criteria for Adverse Events (CTCAE) was used to assess the impact and severity of the level of care required to treat an ADE, should an ADE occur. To determine avoided costs, average healthcare costs (from the Pediatric Health Information System) were used.
A total of 119 patients received 238 clinical interventions associated with clinical impact leading to potential cost avoidance, with ages ranging from 5 months to 23 years (mean: 14.7 years).
For therapeutic categories, there were 29 patients for CF (24%), 31 for IBD (26%), 39 for RIC (33%), and 20 for GH disorders (17%).
According to the results, the overall cost savings was $476,062. The largest savings were associated with drug interaction interventions ($107,248, 23%). Care coordination for additional testing needed before treatment initiation was next ($94,712, 20%), followed by drug-related adverse events ($77,999, 16%) and duration, frequency or suboptimal treatment administration ($71,213, 15%).
From there, necessary medication monitoring came next ($53,676, 11%), followed by undertreatment of conditions due to disease progression ($23,730, 5%). An additional cost savings of $47,483 (10%) was added through other clinical interventions, primarily related to coordination of care activities.
Eight of the 47 reported AEs (17%) were reported to MedWatch due to high severity.
The time spent by the pharmacist on the intervention varied between 0 and 15 minutes (116), 15 to 30 minutes (71), 30 to 45 minutes (23), 45 to 60 minutes (13) and more than 60 minutes (8 ).
The investigators concluded that pediatric HSSP pharmacists performed clinical interventions beyond their daily clinical and operational activities.
Quantifying interventions “demonstrated the high quality of a SP program, which helps to advocate for the expansion of pharmaceutical services,” the authors noted.
The performance data highlighted in the study can be used by health system administrators in contract negotiations with health plans.
SP pharmacists spend a lot of time coordinating care, which can be difficult to attribute to cost savings.
The study authors concluded that “the subjective nature of quantifying impact can be minimized by establishing templates for documenting interventions, tracking published literature, and establishing a review panel.”
Reference:
Yen J, Kim A, Tran K, Cooper A, Tu K. Economic impact of clinical pharmacist interventions in a specialty pharmacy in the integrated pediatric health system. Abstract. Presented at the Health System Pharmacists Mid-Year Clinical Meeting and Expo held in Anaheim, California. From December 3, 2023 to December 7, 2023.
