Background

The role of the pharmacist in primary care (PC) has expanded to focus on medication optimization and management for chronic conditions. However, identifying the optimal pharmacist practice model to maximize pharmacist workload capacity, patient care quality, and PC provider satisfaction remains a challenge. PC clinical and administrative leaders could benefit from pharmacist impact forecasts to justify initiating new or optimizing/expanding current pharmacist services.

Objectives

(1) To describe the development of a PC pharmacist services modeling tool, PCImpact (2) To discuss the use of PCImpact by PC leaders to initiate, optimize, or expand integrated pharmacist services.

Methods

PCImpact was developed and internally tested with 6 clinical/administrative leaders within a federally qualified health center and health system-affiliated primary care organization by: (1) identifying pharmacist practice models, (2) obtaining data input values for PCImpact, and (3) calculating PCImpact output values.

Two types of pharmacist practice models are defined: population health (PH) and direct patient care (DPC). In the PH models, a centralized pharmacist performs one-time, comprehensive or targeted medication reviews with no direct patient interaction. PC providers review and implement pharmacist recommendations. In DPC models, an embedded pharmacist in a PC practice performs patient visits with or without collaborative practice agreements with PC providers.

Default values for all PCImpact data inputs were obtained/tested through literature reviews and discussions with pharmacy and physician leaders, including pharmacist and PC provider time required, and implementation percentage of pharmacist recommendations. PCImpact calculates: (1) pharmacist workload capacity, (2) PC provider time impact, and (3) patient care impact.

Conclusions

PCImpact presents a novel method to objectively forecast the impact of PH and DPC pharmacist services in 2 PC settings. PCImpact outputs showed that a DPC pharmacist practice model can save PC provider time and impact a greater number of patients compared to a PH pharmacist practice model.

中文翻译：

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PCImpact：一种用于预测初级保健药剂师服务影响的建模工具

背景

药剂师在初级保健 (PC) 中的作用已扩大到专注于慢性病的药物优化和管理。然而，确定最佳药剂师实践模式以最大限度地提高药剂师的工作量、患者护理质量和 PC 提供商满意度仍然是一个挑战。PC 临床和行政领导者可以从药剂师影响预测中受益，以证明启动新的或优化/扩展当前药剂师服务的合理性。

目标

(1) 描述 PC 药剂师服务建模工具 PCImpact 的开发 (2) 讨论 PC 领导者使用 PCImpact 来启动、优化或扩展综合药剂师服务。

方法

PCImpact 是由联邦合格的卫生中心和卫生系统附属初级保健组织的 6 位临床/行政领导开发和内部测试的：(1) 确定药剂师实践模型，(2) 获取 PCImpact 的数据输入值，以及 (3)计算 PCImpact 输出值。

定义了两种类型的药剂师实践模型：人口健康 (PH) 和直接患者护理 (DPC)。在 PH 模型中，集中药剂师执行一次性、全面或有针对性的药物审查，无需与患者直接互动。PC 提供者审查并实施药剂师的建议。在 DPC 模型中，PC 实践中的嵌入式药剂师在与 PC 提供商签署或不签署合作实践协议的情况下执行患者就诊。

所有 PCImpact 数据输入的默认值是通过文献回顾和与药学和医师领导者的讨论获得/测试的，包括药剂师和 PC 提供者所需的时间，以及药剂师建议的实施百分比。PCImpact 计算：(1) 药剂师工作负载能力，(2) PC 提供商时间影响，以及 (3) 患者护理影响。

结论

PCImpact 提出了一种新方法，可以客观地预测 PH 和 DPC 药剂师服务在 2 个 PC 设置中的影响。PCImpact 输出表明，与 PH 药剂师实践模型相比，DPC 药剂师实践模型可以节省 PC 提供者的时间并影响更多的患者。