The Effect of Ambulatory Care Pharmacists on Clinic Attendance and Patient Engagement

The Effect of Ambulatory Care Pharmacists on Clinic Attendance and Patient Engagement
Caitlin Pederson, PharmD, M Health Fairview

Background: Patient engagement is critical for improving patient outcomes, but this can be difficult to measure. A surrogate marker often used for patient engagement is primary care provider (PCP) initial visit attendance. It has been shown that older patients with commercial insurance are more likely to have engagement with their PCP and Medicaid patients are least likely to report to PCP visits. It poses the question as to how can the care team with an ambulatory care pharmacist help to improve patient engagement.

Objective: The goal of this study was to assess if patient engagement improved when associated with different patient characteristics, provided services, or provider participation post-discharge clinic appointments. Patient engagement was defined as attendance to an initial PCP visit to establish care.

Practice Description: This study occurred at John Hopkins After Care Clinic (JHACC) in Baltimore, MD, an interdisciplinary post-discharge clinic, whose goal is to decrease hospital readmission and establish primary care follow-up. The main goal of this clinic is to make sure these patients are established with a PCP. The patient population seen here is an urban, underserved population with poor social determinants of health. This clinic utilizes an interdisciplinary approach to address the needs of the patients.

Practice Innovation: JHACC works to reduce barriers to follow-up care by assisting patients in the transition to primary care, focusing on managing all disease states. An interdisciplinary team comprised of physicians/providers, pharmacists, nurses, medical assistants, and community health workers collaborate for each patient encounter. The role of the pharmacist includes medication reconciliation, chronic drug therapy management, patient education, and drug information. This model at JHACC was found to be financially sustainable, generated revenue, and saved over $1 million for the affiliated hospital (i.e., avoidable hospital admissions and ED visits).

Evaluation Methods: Patients who were referred to a PCP between January 2016 and January 2018 from within the system were assessed. Patient engagement was defined as patients who saw a PCP within 8 months after the initial JHACC visit. This time frame was used since it included 95% of the data for new patient appointments. Description statistics were determined using means and proportions for patients who attended PCP visits and those who did not. Chi square tests were also utilized to compare the groups.

Results: The study included 717 patients with 423 (59%)  attending their initial PCP visit and 294 (41%) not attending. Age was found to be significantly different with an average age of 42.1 years in patients who attended initial PCP visits compared to 38.1 years in those who did not (P < 0.001). There was no difference found in attendance between sex, race, or ethnicity. When pharmacists or nurses were involved in the patient visits there was a significant increase in initial PCP visit attendance. Pharmacist involvement resulted in 69.5% attendance versus 30.5% when the pharmacist was not involved (P = 0.02). Additionally, disease counseling (P = 0.001) and medication education (P = 0.01) significantly improved initial PCP visit attendance.

Limitations: Patient attendance to initial PCP visits were used as a surrogate for patient engagement, but there may be other measures that may show engagement or more accurately represent patient engagement. Also, ambulatory care pharmacist roles can vary greatly, and this site was specifically focused on post-discharge visits in conjunction with a medical provider in an urban, underserved population. The outcomes may be different with varying populations and settings. This study did not clearly define what the role of the pharmacist was, making it difficult to replicate and difficult to determine what that the pharmacist was doing that was effective. Pharmacists were also only present in 14.7% of visits (105 visits), so this was a limited sample size. This study was also limited by the design being retrospective, observational.

Conclusion: Ambulatory care pharmacist involvement in post-discharge visits resulted in improved attendance to initial PCP visits. Future studies should be conducted to determine specific pharmacist activities that increase patient engagement, such as adherence interventions, prescription financial assistance, comprehensive medication reviews, etc. This study suggests that medication education and disease counseling have a positive effect on PCP visit attendance, without a clear definition of what this includes.

 

Reference:

  1. Smith K, Dowd-Green C, Emerson A, Bertram A, Stewart R. Does an encounter with the ambulatory clinical pharmacist in the transitional setting play a role in clinic attendance and patient engagement? J Am Pharm Assoc. 2021;61(2). doi:10.1016/j.japh.2020.11.021