More than 50 percent of physicians experience burnout, which can lead to increased depression and higher rates of suicide; poor patient outcomes; and increases in medical errors. One suggested path toward reducing the rate of burnout has been to examine how teamwork can improve satisfaction on primary care teams.
In a recently published study in the Journal of the American Board of Family Medicine, a University of Minnesota-led research team researchers interviewed primary care providers (PCPs)—including physicians, nurse practitioners and physician assistants—to learn how the inclusion of pharmacists in primary care clinics impacts PCPs' clinical work, professional satisfaction and burnout.
Pharmacists in participating clinics provide a defined service called comprehensive medication management (CMM). Through CMM, all medications are assessed to ensure appropriateness, safety, and that they meet desired goals and can be taken as prescribed.
Kylee Funk, lead author and an assistant professor at the College of Pharmacy, Twin Cities, notes the research team found that PCPs described the pharmacist as a collaborative partner and a professional who contributes a complementary knowledge and skill set.
When pharmacists are embedded in a clinical team, PCPs experienced improvement in work-life aspects:
These seven themes identified in the study center around how the pharmacist improved PCP work-life—which includes clinical work and professional satisfaction—were aligned with drivers of burnout previously documented in academic literature.
"As a medical community, we are very concerned about burnout," said Funk. "Our findings are promising for healthcare leaders who are seeking solutions to decrease burnout and improve joy in work. It is exciting to identify that working with a pharmacist may offer very important benefits for clinicians."
Previous research has already shown benefits to patients when pharmacists are part of a collaborative team with PCPs.
Funk notes the U of M study demonstrates that PCP teams that include a pharmacist embedded in the primary care clinic might be one strategy for addressing provider burnout. Future research will continue to focus on PCP-pharmacist working relationships in a more quantitative fashion to further investigate this finding.
Physicians seeking a way to pay for the expertise of a pharmacist in their medical practices could look to Medicare annual wellness visits to help cover the cost, according to a study from the UNC Eshelman School of Pharmacy.
Medicare Part B covers an annual visit to the doctor for the purpose of developing or updating a personalized plan to prevent disease and disability. Pharmacists can conduct these visits under a physician’s supervision and be reimbursed at the same rate. The visit includes activities such as administering a health survey, conducting a complete medication review, and taking measurements of weight, blood pressure, and cognitive function.
Bigger is Better
It takes 1,070 wellness visits a year—or approximately six visits per day—to cover a $120,000 pharmacist’s salary, the study’s authors calculated. Their findings were published in the Journal of the American Pharmacists Association.
For a large medical practice (fifteen physicians), at least 18 percent of its eligible patients must complete an annual wellness visit with a pharmacist to reach $120,000 in reimbursements.
A medium-sized practice (five physicians) needs at least 54 percent of its patients to come in.
A small medical practice with two physicians would not have enough patients to afford a pharmacist funded by wellness visits alone.
UNC Eshelman School of Pharmacy and UNC School of Medicine faculty based in Asheville, North Carolina, conducted the study. They assumed that each practice has 2,000 patients per physician with 20 percent on Medicare. The hypothetical pharmacist in the study is available to see patients nearly thirty-eight weeks a year. The study also accounts for the fact that a patient’s first wellness visit is reimbursed at a higher rate than subsequent visits.
Here’s the Catch
Only 11 percent of eligible patients nationally actually use their wellness visit benefit, according to a 2013 report from the U.S. Department of Health and Human Services. That’s up from 9 percent in 2012. The wellness visits were created in 2011 as part of the Affordable Care Act.
The study authors practice at the Mountain Area Health Education Center clinic in Asheville. MAHEC would be a large practice in the study based on the number of patients seen. Physicians there started conducting wellness visits in 2011 and found them difficult to complete in the fifteen minutes allotted.
MAHEC started a pilot program in 2012 where a pharmacist took over the wellness visits for three physicians. Patients received information about the scope and purpose of the visits before coming in, which helped keep the visits focused and on schedule, says Courtenay Wilson, PharmD, senior author of the study and a MAHEC pharmacist.
“I can listen to their concerns and make sure that patients know that I’m hearing their concerns,” Wilson says. “I then schedule a follow-up visit with a physician who will know all of the issues that we have identified and have up-to-date records for the patient. It’s a nice partnership.”
By January 2013, all wellness visits at MAHEC were automatically scheduled with a pharmacist.
“From the doc’s perspective, the wellness visit takes a fair amount of time,” says Lisa Ray, MD, another author of the study and a MAHEC physician. “Handing it over to someone who is extremely competent frees us up to see other patients in those time slots. The added bonus is that every one of our Medicare patients has a pharmacist looking over their medication list.