Background Given the complexity of solid organ transplant recipients, a multidisciplinary approach is required. To promote medication safety and enable providers to focus on the medical and surgical needs of these patients, our department of pharmacy created a collaborative practice agreement between physicians and pharmacists. Through this agreement, credentialed pharmacists are empowered to provide inpatient services including initiation and adjustment of medications through independent review of laboratory results after multidisciplinary rounds. Objective To evaluate the effect of our collaborative practice agreement on clinical care and institutional finances. Setting An inpatient setting at a large academic medical center. Methods Three transplant pharmacists entered all clinical interventions made on abdominal transplant recipients between September and October 2013 into Quantifi®, a software application that categorizes and assigns a cost savings value based on impact and type of intervention. Main outcome measure The main outcome measures in this study were number and categorization of interventions, as well as estimated cost savings to the institution. Results There were 1060 interventions recorded, an average of 20 interventions per pharmacist per day. The most common interventions were pharmacokinetic evaluations (36%) and dose adjustments (19%). Over the time period, these interventions translated into an estimated savings of $107,634.00, or an annual cost savings of $373,131.20 per pharmacist, or a cost–benefit ratio of 2.65 to the institution. Conclusions Based on our study, implementation of a collaborative practice agreement enables credentialed pharmacists to make clinically and financially meaningful interventions in a complex patient population.
Clinical practice Collaborative practice Immunosuppression Solid organ transplant United States
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There was no outside funding received for the purposes of this study.
Conflicts of interest
The authors declare that they have no conflict of interest.
Sease JM, Franklin MA, Gerrald KR. Pharmacist management of patients with diabetes mellitus enrolled in a rural free clinic. Am J Health Syst Pharm. 2013;70:43–7.CrossRefPubMedGoogle Scholar
Deppe SJ, Nyberg CR, Patterson BY, Dietz CA, Sawkin MT. Expanding the role of a pharmacist as a sexually transmitted infection provider in the setting of an urban free health clinic. Sex Transm Dis. 2013;40:685–8.CrossRefPubMedGoogle Scholar
Prot-Labarthe S, Therrien R, Demanche C, Larocque D, Bussières JF. Pharmaceutical care in an inpatient pediatric hematopoietic stem cell transplant service. J Oncol Pharm Pract. 2008;14:147–52.CrossRefPubMedGoogle Scholar
Ho L, Akada K, Messner H, Kuruvilla J, Wright J, Seki JT. Pharmacist’s role in improving medication safety for patients in an allogeneic hematopoietic cell transplant ambulatory clinic. Can J Hosp Pharm. 2013;66:110–7.PubMedPubMedCentralGoogle Scholar
Manley HJ, Carroll CA. The clinical and economic impact of pharmaceutical care in end-stage renal disease patients. Semin Dial. 2002;15:45–9.CrossRefPubMedGoogle Scholar
Griffin SP, Nelson JE. Impact of a clinical solid organ transplant pharmacist on tacrolimus nephrotoxicity, therapeutic drug monitoring, and institutional revenue generation in adult kidney transplant recipients. Prog Transpl. 2016;4:314–21.CrossRefGoogle Scholar
Martin JE, Zavala EY. The expanding role of the transplant pharmacist in the multidisciplinary practice of transplantation. Clin Transpl. 2004;18:50–4.CrossRefGoogle Scholar
Staino C, Lewin JJ 3rd, Nesbit TW, Sullivan B, Ensor CR. Survey of transplant-related pharmacy services at large comprehensive transplant centers in the United States. Prog Transpl. 2013;23:23–7.CrossRefGoogle Scholar
Taber DJ, Pilch NA, McGillicuddy JW, Bratton CF, Chavin KD, Baliga PK. Improved patient safety and outcomes with a comprehensive interdisciplinary improvement initiative in kidney transplant recipients. Am J Med Qual. 2013;28:103–12.CrossRefPubMedGoogle Scholar
Chisolm-Burns MA, Spivey CA, Garrett C, McGinty H, Mulloy LL. Impact of clinical pharmacy services on renal transplant recipients’ adherence and outcomes. Patient Prefer Adherence. 2008;2:287–92.CrossRefGoogle Scholar
Joost R, Dorje F, Schwitulla J, Eckardt KU, Hugo C. Intensified pharmaceutical care is improving immunosuppressive medication adherence in kidney transplant recipients during the first post-transplant year: a quasi-experimental study. Nephrol Dial Transpl. 2014;29:1597–607.CrossRefGoogle Scholar
Chisolm MA, Vollenweider LJ, Mulloy LL, Wynn JJ, Wade WE, DiPiro JT. Cost-benefit analysis of a clinical pharmacist-managed medication assistance program in a renal transplant clinic. Clin Transpl. 2000;14:304–7.CrossRefGoogle Scholar
Harrison JJ, Wang J, Cervenko J, Jackson L, Munyal D, Hamandi B, et al. Pilot study of a pharmaceutical care intervention in an outpatient lung transplant clinic. Clin Transpl. 2012;26:E149–57.CrossRefGoogle Scholar
Maldonado AQ, Weeks DL, Bitterman AN, McCleary JA, Seiger TC, Carson RW, et al. Changing transplant recipient education and inpatient transplant pharmacy practices: a single-center perspective. Am J Health Syst Pharm. 2013;70:900–4.CrossRefPubMedGoogle Scholar
Wang HY, Chan AF, Chen MT, Liao CH, Tian YF. Effects of pharmaceutical care intervention by clinical pharmacists in renal transplant clinics. Transpl Proc. 2008;40:2319–23.CrossRefGoogle Scholar
Merten JA, Shapiro JF, Gulbis AM, Rao KV, Bubalo J, Lanum S, et al. Utilization of collaborative practice agreements between physicians and pharmacists as a mechanism to increase capacity to care for hematopoietic stem cell transplant recipients. Biol Blood Marrow Transpl. 2013;19:509–18.CrossRefGoogle Scholar
Kiel PJ, McCord AD. Pharmacist impact on clinical outcomes in a diabetes disease management program via collaborative practice. Ann Pharmacother. 2005;39:1828–32.CrossRefPubMedGoogle Scholar
Shane-McWhorter L, Oderda GM. Providing diabetes education and care to underserved patients in a collaborative practice at a Utah community health center. Pharmacotherapy. 2005;25:96–109.CrossRefPubMedGoogle Scholar
Gums TH, Carter BL, Milavetz G, Buys L, Rosenkrans K, Uribe L, et al. Physician-pharmacist collaborative management of asthma in primary care. Pharmacotherapy. 2014;34:1033–42.CrossRefPubMedPubMedCentralGoogle Scholar
Nodzon J, Groppi J, Hilaire M, Martin LG. The future is now: state of practice for credentialing and privileging for pharmacists. Presentation at ASHP Midyear Clinical Meeting. Las Vegas, NV; 2016.Google Scholar
Code of Maryland Regulations (COMAR). 10.34.29.03 (2016).Google Scholar
Alkhateeb FM, Unni E, Latif D, Shawaqfeh MS, Al-Rousan RM. Physician attitudes toward collaborative agreements with pharmacists and their expectations of community pharmacists’ responsibilities in West Virginia. J Am Pharm Assoc. 2009;49:797–800.CrossRefGoogle Scholar
Hlubocky JM, Stuckey LJ, Schuman AD, Stevenson JG. Evaluation of a transplantation specialty pharmacy program. Am J Health Syst Pharm. 2012;69:340–7.CrossRefPubMedGoogle Scholar