Primary care providers believe that comprehensive medication management improves their work-life

Primary care providers believe that comprehensive medication management improves their work-life

Sarah Shockley, PharmD, Fairview Pharmacy Services

Background: Research has previously shown that comprehensive medication management (CMM) services provided by pharmacists contributes to the Triple Aim, which is a goal that focuses on improving patients’ health, enhancing patients’ care experience, and decreasing health care costs. The new Quadruple Aim adds the goal of improving the work-life of health care providers. With over half of all physicians experiencing workplace burnout, it is important to identify what factors could improve provider well-being. The potential role of pharmacists and CMM on these measures has not been established; however, emerging research from Funk et al. suggests that team-based care can improve engagement and decrease provider burnout.

Purpose: To determine the perceived impact of pharmacist-delivered CMM services on physician work-life.

Study Design: PCPs (defined as physicians, physician assistants, or nurse practitioners) from four health systems in Minnesota were selected for the study. Pharmacists from each health system were contacted and asked to help identify two to eight PCPs to be interviewed. Overall, eight pharmacists identified 16 PCPs to be interviewed. Interviews were conducted with one or two interviewers until no new themes were identified showing saturation was achieved. Interviews were semi-structured and focused on the positive and negative effects of CMM on the PCP’s clinical work, professional satisfaction, and burnout. The interviews included questions related to limitations and areas of improvement for CMM. PCPs also completed an activity involving placing notecards with various clinical functions on a 0 to 10 scale to describe how they felt CMM affected that function and why. Two investigators developed a codebook of the themes by independently coding two transcripts using an inductive approach and then had all transcripts coded in the software program NVivo.

Results: Six dyadic and four one-on-one interviews with PCPs were conducted by researchers between September and November 2017. PCPs described pharmacists as collaborative partners whose relationship led them to feel supported, reassured, and less burned out. PCPs described the extensive knowledge that pharmacists have and the time they saved having pharmacists help them decide on a variety of tasks including medications, treatment options, and prescription coverage. PCPs also noted that during a pharmacist’s assessment, medication-related problems are uncovered that otherwise might have been missed. Pharmacists also helped decrease the workload on PCPs by assisting with indirect care such as patient phone calls, inbox messages, and refill requests. PCPs described high satisfaction in the care they were providing because they could rely on CMM services for certain aspects of care. They also noted how CMM helps them achieve their clinic quality measures. The main barriers noted by the PCPs were being unsure if CMM services would be covered for their patients, the possibility of PCPs not having a trusting relationship with their clinical pharmacist, and patients being unaware of the benefits of CMM and being unwilling to attend the appointment. Suggestions for improvement that PCPs offered included having a full-time clinical pharmacist in clinic and having pharmacists identify more patients from the PCPs’ schedules for CMM services. 

Conclusions:While it was acknowledged that pharmacists providing CMM in clinics can result in a cost burden to the clinic, the themes identified in this study shed light on how one can build a value proposition for collaborative CMM services using the Quadruple Aim as a framework. PCPs expressed that they feel having clinical pharmacists providing CMM in their clinic makes them more efficient while providing better care and reducing burnout. Many of the themes identified in the study are connected to five of the seven key drivers of burnout including workload and job demands, work-life integration, social support and community at work, efficiency and resources, and meaning in work.

Key Point: Surveyed PCPs believe that having clinical pharmacists providing CMM services at their clinic positively affects their work-life and reduces burnout.

Reference:

1. Funk KA, Pestka DL, Roth McClurg MT, Carroll JK, Sorensen TD. Primary Care Providers Believe That Comprehensive Medication Management Improves Their Work-Life. J Am Board Fam Med. 2019 Jul-Aug;32(4):462-73.