Value-Added Services in Niche Settings, Such as the ER

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May 09, 2019
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Value-added pharmacy services are not the exclusive bailiwick of community pharmacy. For that matter, nor are they only in the main pharmacy area of the hospital. As discussed in a previous Tip, the implementation of value-added services aims to advance the profession, but not in a way that is blind to the patients we serve or in a vacuum without considering the other players in the health care system. They are performed with an eye toward public health.  The Institute of Medicine (IOM) established three major functions of public health: assessment, policy development, and assurance. In the assessment function, clinical pharmacists identify mechanisms to reduce untoward medication-related events. In the emergency department (ED) of a hospital, many patients enter with acute and serious conditions while other patients, given inadequate access to primary care services, utilize the ED as a proxy for visiting a primary care physician. However, even the latter patients often present with exacerbation of uncontrolled, multiple comorbidities and often have had inadequate treatment. 

Dryden and Dewhurst reported on the integration of a clinical pharmacist in an ED at an urban hospital. Over a 5-week period, the ED pharmacist performed 421 interventions, with 204 (48%) of those accepted by the prescriber. After review, 53.9% of interventions were considered significant, and 52.9% were given a probability of patient harm of ≥50% had the intervention not occurred. Interventions resulted in an increase in direct medication costs of $1270, but generated a cost avoidance of $160,709. The projected direct medication cost avoidance for one year was over $1.6 million.

Pharmacists and pharmacy managers can find any number of places for integration of services with those of existing medical services offered by other professionals. Effective management is paramount, because failure to offer complementary and supportive services, rather than competitive ones, could result in failure. Additionally, successful implementation requires more than just clinical knowledge. In the case described here, there were certainly some successes; however, the proportion of pharmacist recommendations accepted could hopefully be improved.

Additional information about Value-Added Pharmacy Services as a Component of Enhancing Pharmacists’ Roles in Public Health can be found in Pharmacy Management: Essentials for All Practice Settings, 4e. If you or your institution subscribes to AccessPharmacy, use or create your MyAccess Profile to sign-in to Pharmacy Management: Essentials for All Practice Settings, 4e. If your institution does not provide access, ask your medical librarian about subscribing.

1Dryden L, Dewhurst NF. Integration of clinical pharmacist into a Canadian, urban emergency department: A prospective observational study. Intl J Pharm Pract. 2018.  https://doi.org/10.1111/ijpp.12481.

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Shane Desselle

Professor of Social and Behavioral Pharmacy, Touro University California

1 Comments

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Shane Desselle 2 months ago

Niche settings might possibly even more fertile ground than more “traditional” ones.  An you imagine what a really good pharmacist with a good plan and design can do to help patients in the ER? What’s nice about the study referenced here is that they quantified and demonstrated evidence of those benefits.