Workload Evaluation of Clinical Pharmacists in the Ambulatory Care Setting

Workload Evaluation of Clinical Pharmacists in the Ambulatory Care Setting
Alicia Smith, Pharm.D., Welia Health

Purpose: The main purpose of this workload evaluation study was to articulate and measure the time spent on prespecified daily activities by clinical pharmacists in an ambulatory care setting. This study also assessed for differences in the distribution of workload between pharmacists and aimed to identify current inefficiencies in workflow and areas of opportunity for optimizing pharmacist-delivered patient care in the ambulatory care setting.

Study Design: This study was a prospective, ethnographic, observational pilot study conducted at six pharmacist-integrated, multidisciplinary, ambulatory care clinics. The clinical pharmacists needed to have been employed in their current position for six months or more to be included in the study. Participants completed a survey describing their demographics, clinical site characteristics, and self-reported engagement in direct patient care activities. Additionally, participants were observed for up to three non-consecutive clinic workdays where clinical and administrative workload activities were evaluated through direct observation. Observation data was used to calculate the proportion of time spent on pre-visit, visit, post-visit, administrative, or other activities. Additionally, time spent on these activities was documented by the observer and categorized according to each step of the pharmacists’ patient care process (collect, assess, plan, implement, follow up, and collaborate/communicate/document). The primary outcome was to measure the time spent on daily activities performed and was analyzed using descriptive statistics.

Results: Ten clinical pharmacists were observed for a total of 26 clinic workdays and completed 164 patient encounters; 103 (63%) encounters were targeted (one disease state), 31 (19%) encounters were dual focused (two disease states), and 30 (18%) encounters were comprehensive (three or more disease states). Of the prespecified workload activities, participants spent the greatest amount of time documenting patient care activities after the visit, regardless of the visit type. Time for documentation was a mean (SD) of 6.6 (6.7) minutes for targeted visits, 8.0 (8.2) minutes for dual focused visits, and 7.6 (7.7) minutes for comprehensive visits. Additionally, participants spent a significant amount of time in the collection phase of the patient care process, spending an average of approximately three minutes on each prespecified activity in this category. The plan and implement steps had less prespecified activities, and participants spent less time in these steps. A positive correlation was identified between years in clinical practice and time spent on collect and plan activities (r=0.653 [P=0.0407] and r=0.680 [P=0.0304], respectively), and a negative correlation with time spent on follow up activities (r=-0.641 [P=0.0460]). 

Conclusions: This study articulated the daily workload activities that are performed by a select group of ambulatory care clinical pharmacists. There was variation in clinical and administrative activities seen among participants. However, years of practice experience, postgraduate training, board certification, duration of practice at the site, and site characteristics did not affect the distribution of time spent on activities comprising the patient care process, with all participants spending the greatest amount of their time documenting patient care activities.

Key Point: This study helps provide a more complete understanding of the ambulatory care pharmacist’s daily workload and potentially assists in identifying areas for improvement in efficiency. It demonstrated that pharmacists spend the greatest amount of their time documenting patient encounters.  

References: 

  1. Van Drill E, Schumacher C, Kliethermes MA, Borchert JS, Buros Stein A. Workload Evaluation Of Clinical Pharmacists In The Ambulatory Care Setting. J Am Coll Clin Pharm. 2020;doi: 10.1002/jac5.1242.