Impact of Internal Medicine Clinical Pharmacy Specialists at an Academic Medical Center.

Abstract

Introduction: In 2024, the American College of Clinical Pharmacy (ACCP) completed a nationwide survey to describe the practice of internal medicine clinical pharmacy specialists (IMCPS). IMCPS were asked to report clinical interventions, rates of intervention acceptance, and the significance of those interventions. However, this study did not provide any description of cost avoidance (CA) provided through IMCPS interventions. The PHARM-CRIT trial identified that for each critical care pharmacist hired, there was a CA of about $3 to 9 per $1 spent on pharmacist salary. Similarly, the PHARM-EM study found there was a CA of $1 to 10 per $1 spent on an emergency medicine pharmacist. There is limited data on the cost benefits specific to IMCPS. This study aims to identify the impact of IMCPS at an academic medical center, specifically evaluating the CA provided.

Objectives: The primary outcome of this study is the mean number of interventions per IMCPS per 8-hour shift and total CA generated.

Methods: This prospective observational study included interventions related to adverse drug event prevention, resource utilization, hands-on care, drug information, and protocol implementation completed by IMCPS. Intervention severity was assessed utilizing the Medication Error Index. Intervention CA was estimated using CA described in the study by Hammond et al. The primary outcome of this study is the mean number of interventions per IMCPS per 8-hour shift and total CA generated. Secondary outcomes include the number of interventions completed, type of intervention completed, severity of intervention, time spent per intervention, average CA per intervention and mean CA per IMCPS.

Results: Over a 28-day period, eight IM clinical pharmacy specialists completed 1,826 interventions. The average number of interventions completed by a pharmacist was 228 (IQR: 115-270) which equates to 12.26 interventions per 8-hour shift worked. The total CA for 28 days was $785,772.86 which equates to $10,215,047.24 per year. Per intervention completed by a pharmacist, $430.32 of cost was avoided. For every dollar spent on an IM clinical pharmacy specialist's salary, $9.29 was avoided.

Conclusion: IMCPS provided significant CA and medication error prevention, specifically in areas of adverse drug event prevention and resource utilization.