PHarmacist Avoidance or Reductions in Medical Costs Considering Board of Pharmacy Specialties Certification (PHARM-BPS)

Abstract

Introduction: Clinical pharmacists bring unparalleled medication expertise, but quantifying their impact on a health system's bottom line remains unestablished. Objective: To classify interventions by pharmacists with and without board certification and quantify the cost avoidance (CA) from accepted interventions. Methods: This multicenter prospective observational study, conducted between August 2018 and January 2019, included board certified (BPS) and non-board certified (Non-BPS) emergency medicine (EM) and intensive care unit (ICU) clinical pharmacists from 89 U.S. institutions. Primary outcomes included the quantity, type, and acceptance of interventions and the CA generated by BPS pharmacists compared to Non-BPS pharmacists. Results: 287 pharmacists (227 BPS, 60 Non-BPS) at 89 centers provided care throughout 4184 shifts. BPS pharmacist provided more interventions (overall: 63 693 vs 8690; per shift: 18.8 vs 10.9, P < .001) with higher acceptance (98.2% vs 97.6%, P < .001). Accepted interventions per shift included adverse drug event prevention (2.0 vs 1.6, P = .17), resource utilization (3.6 vs 1.7, P = .007), individualization of patient care (9.7 vs 5.3, P = .05), prophylaxis (0.4 vs 0.3, P = .99), hands-on care (1.4 vs 0.9, P = .99), and administrative/supportive tasks (1.8 vs 1.1, P = 0.). BPS pharmacists generated greater mean CA per intervention ($873 vs $801), patient day ($961 vs $501), shift ($8112 vs $4828) and annum ($1 946 942 vs $1 158 784) (P < .001 for all). The CA to salary ratio was 10.5:1 for BPS and 6.3:1 for Non-BPS pharmacists. Conclusion: BPS pharmacists in the ED and ICU generated greater CA and a higher monetary CA to salary ratio than Non-BPS pharmacists.

Keywords: administration; cost-effectiveness; pharmacist; value.