Mate M. Soric, Pharm.D., BCPS, Jason E. Glowczewski, Pharm.D., M.B.A., Rachael Lerman, Pharm.D., BCPS
University Hospitals Geauga Medical Center, Chardon, Ohio
Advanced pharmacy services are known to improve patient care but have not become widely available in smaller hospitals. Data from the 2013 ASHP survey of pharmacy practice in hospital settings showed that fewer than 45% of hospitals with less than 200 staffed beds reported that pharmacists routinely attended rounds while hospitals with greater than 600 staffed beds provided these services at a rate of 100%. This disparity becomes more important when considering that hospitals with less than 200 staffed beds make up over 70% of all institutions in the United States while only 2.8% have greater than 600 staffed beds. With the advent of the Pharmacy Practice Model Initiative, advanced pharmacy services must continue to expand beyond large, academic facilities. The layered learning model (LLM) represents one avenue to accomplish this goal. This study aims to quantify the economic and patient satisfaction impact of a LLM in a small, community hospital.
The main components of the LLM include: rounding with the internal medicine service to provide drug therapy recommendations that improve care while decreasing costs, and providing patient education via large group sessions and one-on-one medication education rounds. To maintain these services, a clinical pharmacist leads a team of 2 PGY-1 pharmacy residents and a total of 24 Advanced Pharmacy Practice Experience (APPE) student-months per year. Each student completes a 2-month internal medicine rotation. Pharmacy residents are assigned to 3 internal medicine rotations and 1 medication education rotation. This provides internal medicine service coverage nearly every month of the year. Trainees spend roughly half their day engaged in patient work-up and interprofessional rounding. For the remainder of their time, trainees are used as pharmacist extenders to improve patient satisfaction scores, counseling patients on their assigned units on the indications and common side effects of their new medications.
Over the 2-year study period, a significant impact was realized in the areas of drug expenditures and patient satisfaction. The intervention group consisted of 2,737 discharges compared to 3,983 discharges for the control group. At baseline, the two groups were largely comparable, including similar geometric mean drug expenditures per discharge and length of stay. After implementation of the LLM, the difference in geometric mean total drug costs per discharge was $48.63 ($161.52 versus $210.15, p<0.001), favoring the LLM group. In subgroup analyses, drug costs for pneumonia and urinary tract infection were significantly lower in the LLM group. Patient satisfaction with medication education also improved during the LLM period when compared to the pre-implementation period (8th percentile versus 39th percentile, p<0.001).
The LLM is an effective strategy for the rapid expansion of advanced pharmacy services, resulting in significant improvements in drug expenditures and patient satisfaction. With widespread adoption, the model could drastically increase the level of care for all patients by adding pharmacy services to the patient care team in institutions that previously could not offer such services.