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Collaborative pharmacy approach eases physician workload

May. 15, 2019, 10:45 AM

The transplant collaborative pharmacy team includes, from left, Anthony Langone, MD, Keren Johnson, PharmD, CSP, and Rachel Chelewski, PharmD, CSP.
The transplant collaborative pharmacy team includes, from left, Anthony Langone, MD, Keren Johnson, PharmD, CSP, and Rachel Chelewski, PharmD, CSP. (photo by Anne Rayner)

by Kelsey Herbers

Thanks to a collaborative pharmacy practice agreement (CPPA) initiated between Vanderbilt University Medical Center’s Transplant Pharmacy and Renal Transplant Clinic, physicians are spending less time authorizing prescriptions and more time with patients.

The agreement, which launched two years ago, allows pharmacists to refill most medications without a physician’s involvement. Physicians who were authorizing 72% of immunosuppressant prescriptions in the Renal Transplant Clinic just three years ago are now handling only 9% of refill requests.

According to Anthony Langone, MD, associate professor of Medicine in the Division of Nephrology and Hypertension and medical director for the Medical Specialties Clinic, which includes transplant nephrology, some of the clinic’s six physicians were receiving more than 500 refill requests per month before the agreement was initiated.

“Our message basket volumes were through the roof, and more physician time was being used to handle these pharmacy requests as opposed to taking care of patients,” said Langone. “We had reached an impasse. We needed relief.”

Alongside transplant pharmacists Rachel Chelewski, PharmD, CSP, and Keren Johnson, PharmD, CSP, Langone worked to develop the approach shortly after the Tennessee Pharmacist Association and the Tennessee Medical Association enacted rules allowing the creation of such agreements in July 2014.

The approval process took more than two years as the plan was reviewed internally and by the Tennessee Board of Pharmacy and the state’s attorney general.

Since pharmacist integration was added to the clinic in 2015, the total number of renal transplant prescriptions at VUMC increased from 13,523 to 45,320 at the end of 2018. The pharmacy team has grown from eight to 24 members, and pharmacists now authorize 85% of the clinic’s immunosuppressant refill requests.

In February 2019, the pharmacists filled more than 10,000 prescriptions and serviced almost 2,000 patients.

The agreement also makes refilling prescriptions easier for pharmacists, as they no longer need to connect with each patient’s physician before granting refills. Eliminating steps from the process means quicker turnaround times for patients, leading to increased patient satisfaction.

“The CPPA has given me more autonomy as a pharmacist and allowed me to better service the patient from both the clinic and pharmacy aspects,” said Johnson.

“Along with patient counseling and medication review, having access to the electronic medical record and being embedded in clinic allows me to see the patient in clinic, address any insurance or financial concerns, pinpoint any modifications that may be needed and submit prescriptions. I am also able to continue on with the pharmacy services, connect patients to other Vanderbilt resources as needed and arrange for the patient to receive their medications.”

Seven internal audits of the CPPA have also proven the safety of the approach. The streamlined process ensures close monitoring of post-transplant patients, who require complex medication regimens to ensure the survival of the transplanted organ and their overall well-being.

“We have been able to expand our roles as pharmacists and, in the process, reduce physician and nurse workload in our clinic,” said Chelewski. “We have a good relationship with our physicians, which is essential to making a CPPA successful. They trust our expertise and encourage patients to utilize VUMC’s Transplant Pharmacy services.”

While the CPPA is currently only available for the Renal Transplant Clinic, VUMC is working to initiate CPPAs in other clinics across Vanderbilt using the same design.

Data from the Renal Transplant Clinic’s CPPA has been accepted for oral presentation at the American Transplant Conference in June 2019.

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