Gallup survey puts pharmacists in their place
Gallup survey puts pharmacists in their place
A report on the state of the industry
How does your pharmacy operation stack up against those around the country? A newly published Gallup survey of 392 integrated health systems commissioned by the American Society of Health-System Pharmacists (ASHP) in Bethesda, MD, is offering one of the more comprehensive and recent set of answers.
ASHP unveiled the survey, compiled in June and July 1997, at its winter mid-year conference in December. Eighty-seven percent of respondents were pharmacists, and the survey included hospital-based systems (45%), independent practice association (IPA) model health maintenance organizations (34%), staff or group model HMOs (11%), and physician based systems (10%).
In general, the survey shows that dispensing still reigns a pharmacist’s day, while tracking adverse drug reactions, monitoring compliance, and contributing to formulary decisions follow close behind. Duties such as conducting specialized clinics or holding prescribing authority are at the bottom of the heap in terms of how pharmacists spend their time.
The numbers on automation hardware and integrated electronic medical records are low overall, but the satisfaction with the systems being used is high.
Also, mixing the good with the bad, the number of pharmacists included on interdisciplinary teams fell just below 50% in all systems combined, but administrative and physician support for pharmacy inclusion is quite high.
Including formulary management, record keeping, clinical services, daily duties, the use of pharmacy benefit managers, performance evaluation, staffing levels, payer structures, and a focus on ambulatory patients, the survey offers a good roundup of the present and draws some conclusions about the future.
Overall, by combining scores from the four types of integrated systems polled, 39% of respondents cited the use of a moderately restrictive formulary, although the use of an open formulary (28%) and a closed or highly restrictive formulary (22%) were not far behind.
As expected, HMOs reported higher numbers of restrictive formularies between 32% and 35% than did their hospital- or physician-based counterparts. The use of common formularies for ambulatory patients in all groups was relatively high at 67% overall, while 50% overall cited a common formulary for all parts of the health care system.
More specifically, hospital systems cited a moderately restrictive formulary as the norm (48%), with open formularies (28%) and closed ones (14%) following. The same holds for physician-based systems reporting moderate (37%), open (23%), and closed (17%) formularies. The differences were far fewer in HMOs, where IPA models reported moder- ate (31%), open (28%), and closed (32%) formularies and staff or group HMOs reported moderate (31%), open (31%), and closed (35%) formularies respectively.
Hardware and software
The use of electronic medical records, which the pollsters defined as computerized patient-specific information on patient care plans, were found in 27% of all the systems combined. Of those using software for ambulatory patients, 59% overall said pharmacy information was included, while 19% said they plan to include pharmacy information during the next year.
More specifically, hospital-based systems had the highest use at 35% (29% for ambulatory patients), followed by physician-based systems (29%), staff or group-model HMOs (22%), and IPA-type HMOs (18%). The numbers of the latter three using software for ambulatory patients were close to the overall usage, at 24%, 21%, and 15%, respectively.
Overall, 15% of the respondents have automated dispensing in place; 45% of it is used to dispense ambulatory patient scripts. Specifically, automated systems were used most by staff or group model HMOs (22%), physician-based systems (18%), hospital systems (15%), and IPA-model HMOs (11%).
Staff or group-model HMOs use automation to dispense 62% of their prescriptions, followed by 49% for hospital-based systems, 31% for IPA HMOs, and 25% for physician-based systems.
Services and functions
Overall, 49% of respondents said that a pharmacist is part of the interdisciplinary ambulatory care team in their system, led by staff or group HMOs (59%), IPA models (53%), hospital-based systems (47%), and physician-based systems (44%).
Related questions charting the support for including a pharmacist in such teams, asked separately of medical staff and senior management, never fell below 75% no matter what the setting.
As for daily pharmacist functions, 45% responded that dispensing (deemed "distributive" functions in the poll), led the way, followed by clinical functions (30%) and administrative/ managerial functions (21%).
More specifically, the patterns differ among the four health care settings. For staff- or group-model HMOs, the response was 63% distributive, 23% clinical, and 14% administrative. IPA-model HMOs reported just 25% distributive functions, 35% clinical, 36% administrative, and 4% "other." Hospital-based systems reported 53% distributive, 30% clinical, 13% administrative, and 4% other, while physician-based systems reported pharmacist duties as 52% distributive, 21% clinical, 22% administrative, and 5% other.
The survey does not correlate detailed functions to specific systems, but does rank 18 types of functions by name with an overall response.
Tracking adverse drug reactions lead the way, with 81% naming it as a pharmacist duty, followed by monitoring compliance (78%), using pharmacoeconomics for formulary considerations (76%), drug utilization review or drug use evaluation functions (76%), patient counseling per script (75%), and monitoring outcomes (71%) as the highest types of functions.
The numbers fell when the conducting of wellness or prevention programs was sought (58%), down to the conducting of specialized clinics (33%) and holding prescribing authority (16%).
Conclusions
Based on the numbers and the correlation among sets of questions, the survey’s authors note that pharmacists increasingly need and increasingly need to learn the intricacies of pharmacoeconomic data as their roles in formulary management continue to climb; they must have access to that data as well.
Similarly, based on the types of nondispensing functions being done (outcomes monitoring, wellness programs, academic detailing, performance report card preparation, and even negotiating contracts, for example) pharmacists must have access to electronic medical records. And though only 23% surveyed have such access, the authors predict that number will increase as those functions become routine for pharmacists, which the authors also predict. Along those same lines, as the numbers show, more software tracking of ambulatory patients means more pharmacist inclusion in patient care.
In terms of predictions, noting that the majority of all four systems contract services with a community pharmacy network, the authors suggest that community-based pharmaceutical care "is the emerging mode."
And finally, they warn ambulatory care pharmacists that based on the survey results, financial performance measures alone are on the way out, and documented contributions to clinical, humanistic, and economic outcomes are in.
[Copies of the full 24-page survey are available through ASHP at (301) 657-3000, ext. 1283, or from co-publisher Pfizer at (800) 879-3477.]
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