Pharmacists Providing Pall Care: Showing Positive ROI

Topic: Expanding the IDT

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Objective:

To show a positive return on investment (ROI) for a Pharmacist providing Palliative Care services on a hospital-based Palliative Care team.

Background:

One rate limiting factor of the quality and financial impact a Palliative Care consult service can have in a healthcare system is the number of Providers available to deliver care. Adding a Pharm.D. position to the team is often overlooked as a viable solution. Not only can they serve as a medication expert, influence prescribing trends, increase medication safety, but in most states they can enter into a Collaborative Practice Agreement with the physicians. This enhances the pharmacist’s ability to practice at the top of their license and serve as an extension of Provider services. Considering integration of a Pharm.D. into Palliative Care teams mandates the establishment of a ROI for such positions.

Methods:

A 16-month retrospective review was done involving Palliative Care patients at a 650 bed tertiary medical center. Information regarding clinical pharmacists’ activity, identification of preventable adverse drug events (pADEs), and the management of symptoms by the Pharm.D. was gathered from the electronic medical record (EMR). Demographic comparison of patients and pharmacists’ clinical activity was performed between multiple facilities in the health system with active Palliative Care teams. One of the three facilities compared included an integrated Pharm.D. Palliative Care team member. For Palliative Care patients during the Palliative Care consult period, statistical analysis was done looking at the number of pADEs identified by PharmDs at two facilities. A ROI was calculated using a literature-based cost of pADEs in a hospitalized patient and Provider time saved.

Results:

There was a statistically significant difference in rates of pADEs between all pharmacists at the facility with a Palliative Care Pharm.D. compared to all pharmacists at a similar facility in the health system without a Palliative Care Pharm.D. At the facility with a dedicated Palliative Care Pharm.D., there was a statistically significant difference in rates of pADEs between non-Palliative Care pharmacists and the Palliative Care pharmacist plus all other pharmacists. In logistic regression, the Palliative Care pharmacist was 5 times as likely to identify a pADE regardless of facility or patient age. A ROI of $1,177,298 per year was calculated based on identification of pADEs and symptom management care rendered as an extender of Provider services.

Conclusion:

From a fiscal, quality and patient-driven perspective, there is an unmet need for Providers in Palliative Care. There are patients who want and qualify for these services yet do not have access to them. A Doctor of Pharmacy has unique qualifications and can contribute to the quality and value of care provided to a Palliative Care patient and their family in ways that are currently unsatisfied because this discipline’s perspective is left out of the care equation. Based on the results of this analysis, there is a minimum ROI of $1,177,298 per year demonstrated for a Palliative Care Pharm.D. This more than justifies a Pharm.D. salary and should validate acquisition of these positions for Palliative Care teams nationally.

Author

Co-authors

  • Richard D. Gerkin, MD, MS, FACP, FACMT
  • Stacie Pinderhughes, MD
  • Steven C Kisiel, MSIE

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