Abstract
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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
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.
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.
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.
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.
Manley HJ, Carroll CA. The clinical and economic impact of pharmaceutical care in end-stage renal disease patients. Semin Dial. 2002;15:45–9.
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.
Martin JE, Zavala EY. The expanding role of the transplant pharmacist in the multidisciplinary practice of transplantation. Clin Transpl. 2004;18:50–4.
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.
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.
Musgrave CR, Pilch NA, Taber DJ, McGillicuddy JW, Chavin KD, Baliga PK. Improving transplant patient safety through pharmacist discharge medication reconciliation. Am J Transpl. 2013;13:796–801.
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.
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.
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.
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.
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.
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.
U.S. Department of Health and Human Services. Centers for Medicare and Medicaid Services; Medicare program; hospital conditions of participation: requirements for approval and re-approval of transplant centers to perform organ transplants. 2016. https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/downloads/transplantfinal.pdf. Last Accessed 16 Nov 2016.
Wang I, Dopheide JA, Gregerson P. Role of a psychiatric pharmacist in a Los Angeles “skid-row” safety-net clinic. J Urban Health. 2011;88:718–23.
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.
Kiel PJ, McCord AD. Pharmacist impact on clinical outcomes in a diabetes disease management program via collaborative practice. Ann Pharmacother. 2005;39:1828–32.
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.
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.
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.
Code of Maryland Regulations (COMAR). 10.34.29.03 (2016).
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.
Hlubocky JM, Stuckey LJ, Schuman AD, Stevenson JG. Evaluation of a transplantation specialty pharmacy program. Am J Health Syst Pharm. 2012;69:340–7.
U.S. Department of Health and Human Services. Centers for Medicare and Medicaid Services; Medicare program; Medicare claims processing manual: chapter 12—Physicians/nonphysician practitioners. 2016. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf. Last Accessed 16 Nov 2016.
Funding
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.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ravichandran, B.R., Gillespie, M.W., Sparkes, T.M. et al. Collaborative practice agreement in solid organ transplantation. Int J Clin Pharm 40, 474–479 (2018). https://doi.org/10.1007/s11096-018-0604-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11096-018-0604-1