Access and acceptance of pharmacist recommendations through an eConsult service

Background

An important aspect of health care quality is access to care from providers and pharmacists. The University of Vermont Health Network (UVMHN) Pharmacy eConsult service was established in October 2021 as a way for primary care clinicians without colocated pharmacists to have access to pharmacy services. Previous studies have shown the value of pharmacy eConsult services.

Objectives

The primary objective was to describe acceptance of pharmacy eConsult recommendations by primary care clinicians within our health system.

Methods

A retrospective chart review study of UVMHN Pharmacy eConsults was completed from October 2021 to August 2023. Pharmacy eConsults related to formulary coverage, prior authorization, or cost assessment were excluded. eConsults were categorized based on consult question type and evaluated for acceptance of recommendation. The data were categorized by type of recommendation to better understand pharmacist recommendation patterns and intervention types. eConsults were considered accepted if the ordering clinician endorsed part or all of the pharmacist’s primary or contingency recommendation in a patient encounter. Recommendations that were not implemented or the outcome that was unable to be determined based on documentation was considered not accepted.

Results

The most frequent types of eConsults included suspected adverse drug reaction (26.9%), medication optimization (24.7%), and diabetes-specific medication optimization (14.0%). Of the 93 eConsults placed, 88 pharmacists’ recommendations (94.6%) were accepted. A total of 84 primary recommendations (90.3%) were accepted, 4 contingency recommendations (4.3%) were accepted, 4 outcomes (4.3%) were missing, and 1 recommendation (1.1%) was not accepted. Approximately 25% of the patients were affected by one or more social determinants of health, the most common of which were financial resource strain, food insecurity, and housing stability.

Conclusion

This study found that most of the pharmacist recommendations from eConsults were accepted, which highlights the importance and value of continuing a pharmacy eConsult service.