Impact of Medication Onboarding: A Clinical Pharmacist-Run "Onboarding" Telephone Service for Patients Entering a Primary Care Practice

Abstract

Background: Previous studies have demonstrated the role of pharmacists during periods of transition of care. However, there are minimal studies that evaluate the impact that a pharmacist can have when a patient transitions his or her care to a new primary care provider (PCP). Objective: To assess the impact of a pharmacist-run medication "onboarding" service for patients new to a primary care (PC) practice. Methods: This prospective cohort study was approved by an institutional review board. Patients ≥50 years old and new to a PC practice were called by a pharmacist to obtain a medication list and identify any medication issues and recommendations. Recommendations were documented in the electronic medical record (EMR) and provided to the PCP prior to patients' first appointments. After each appointment, the EMR was reviewed to determine the status of recommendations. As a comparison, the medication list and PCP's initial appointment notes were reviewed for a similar cohort of patients not receiving a call. Medication-related actions taken at new patients' first appointments were then compared between the pharmacist-assisted (intervention) and usual care (control) groups. Results: Forty-two percent versus 15% of medication issues were enacted in the intervention and control groups (P = .001), respectively. Seventy-seven percent of PCPs found the service beneficial and time-saving during initial new patient visits; 85% felt the service helped them manage patients' medication therapy. Conclusion: A pharmacist-provided medication "onboarding" service results in significantly more medication issues addressed by the PCP compared with new patient visits not preceded by this service.

Keywords: adult medicine; clinical pharmacy; medication errors; medication safety; pharmacist/physician issues.

Figure 1.

(A) Categorization of cost recommendation made in the control group. (B) Categorization of cost recommendations made in the intervention group. ^aWinback is a term used by our institution to describe patient’s filling prescriptions at our onsite pharmacy. ^bIncreased encounters included scheduling a patient for an IM appointment who was not originally scheduled or had cancelled their appointment. ^cWhile reviewing the EMR of control patients it was discovered by the clinical pharmacist that the PCP sometimes would discuss the patient being on a certain medication in the progress note, but not enter it into the medication list in the EMR, thus resulting in an incomplete medication list. ^dSwitching from a nonpreferred to preferred medication included switching from a medication that was not on our institution’s formulary to one that was on the formulary. ^eExamples of recommendations classified as others include discontinuation of duplicate therapy or unnecessary medication or initiation of a medication. ^fDrug tapering included tapering a patient off of medications such as a proton pump inhibitor. ^gDrug interaction included those that would lead to adverse effects or impact patient’s quality of care. ^hMedication adjustments included changing the dose or schedule of a medication.