Implementation of an enhanced medication access workflow within a health-system specialty pharmacy: Impact on patient and clinician experience.

Abstract

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Purpose: The initiation of specialty medications is associated with patient access challenges and clinician burden. This evaluation assessed the impact on patient and clinician experience of an intervention to improve medication access by investing resources upstream of the prescribing step.

Methods: The specialty pharmacy intervention was designed to improve medication access within 5 medical specialty clinics by utilizing an embedded medication access team assigned to patients and prescribers of targeted medications. Using a multimethods evaluative approach to quantitatively assess associations between the referral process and patient experience, we analyzed the emotional valence of patient portal messages using a retrospective cohort study within the event study framework of a nonrandomized, stepped wedge implementation design. Semistructured qualitative interviews provided an understanding of clinician experience.

Results: The intervention was associated with an increase in the net positive emotional valence of patient portal messages (average marginal effect, 5.3; 95% CI, 3.8-6.8; P < 0.001). Except for patients seen by gastroenterologists for irritable bowel disease, patients cared for in all other specialties experienced statistically significant increases in net positive valence in the primary analysis. Regarding clinician experience, 4 major interrelated themes emerged from 17 qualitative interviews with prescribers and pharmacists: (1) decreased clinician burden, general praise, (2) improved experience and satisfaction, reduced anxiety and concerns, (3) rewarding praise for other prescribers/colleagues, and (4) excellent coordination, efficiency, and speed.

Conclusion: Investing staff resources before, during, and after the prior authorization process greatly improved clinician experience. The positive valence of patient portal messages also increased, suggesting patient experience improvements.