Working With Consultants:
References and Tips
Introduction
Due to the growing cost of health care and changes in reimbursement, health care systems are
aggressively looking at expenses in many areas to determine if services can be provided more
efficiently, or are even necessary. Pharmacy costs are not exempt from this review.
Prescription drug expenditures are an important component of overall health care
expenditures. “Increased utilization and access to drugs attributable to the increased aging
population and expanded insurance coverage, along with the launch of new and expensive
medications, are the primary factors raising drug expenditures, while patent expirations and
the availability of less-expensive generic products are the primary factors reducing drug
expenditures.” (Am J Health-Syst Pharm. 2013; 70:52-39.) Prescription drug expense has been
variable. The Center for Medicare & Medicaid Services (CMS) projects a 2.9% growth in drug
expenses in 2012, 2.4% in 2013, and 8.8% in 2014 due to increases in the number of the newly
insured.(CMS, National Health Expenditure Projections 2011-2021) Typically, 80% of a
pharmacy's expense is for medications and 20% is for personnel. (Am J Health-Syst Pharm.
2010; 67:300-11.) In other hospital departments, personnel may account for 60% expenses.
(Expense estimates may vary between health-systems due to a variance in services offered.)
Pharmacy personnel expenses have also increased with the greater utilization of drug therapy.
Therapies once administered in the inpatient setting are now given in clinics, infusion centers
and other outpatient settings. In addition, the increased use of biotechnology products with
increasingly sophisticated drug delivery systems has increased the time for the preparation and
handling of drug products in the pharmacy. Increased regulatory requirements and increased
use of computer systems and automated drug distribution systems has also added to training
and staffing requirements. Other factors, such as widespread and critical drug shortages, have
added to the staffing demands of pharmacies.
The Pharmacy Practice Model Initiative (PPMI) is built on the evidence that an increased role
for the pharmacist in direct patient care as part of the patient care team has the potential for
better outcomes and thus lower patient care expense. (Am J Health-Syst Pharm. 2010;
67:1624-1634.) In order to efficiently expand the pharmacist role, PPMI advocates an increased
and expanded role for pharmacy technicians and the expanded use of automation and
information technology. The system changes advocated by PPMI are very advanced in some
practice settings and rudimentary in others. This creates a dichotomy when looking at
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pharmacy staffing levels in those environments with sophisticated pharmacy services compared
to those with lower pharmacy service levels.
In light of this environment, health-system administrators are increasing the use of consultants
to evaluate overall costs and make recommendations to improve efficiency or eliminate
programs. Some of the consultants are hired to focus on a specific topic, such as the supply
chain, inventory management, or the use of blood products. Consultants may also be hired to
focus on a specific department, such as the pharmacy department. Further, a consultant may
be hired in order to address regulatory compliance or a program change, such as information
technology implementation. In other cases, a specific concern, such as a financial challenge or
a budget shortfall, may prompt a broad review of the organization, including the pharmacy
department.
This document focuses on potential consultant recommendations for reducing pharmacy
services. This document will not address other areas a consultant may focus on, such as:
•
•
•
Drug inventory and/or drug expense
Revenue management
Pharmacy efficiency and skill mix.
The table below recommends resources for readers who are interested in learning more about
these other areas.
Drug expense
and
inventory
management
Revenue
management
ASHP Guidelines on Medication Cost Management Strategies for Hospitals and
Health Systems. Am J Health –Syst Pharm. 2008; 65:1368-84.
American Society of Health-System Pharmacists (ASHP). Sections and Forums.
Section of Ambulatory Care Practitioners. Practice Resources. Reimbursement
Resources
http://www.ashp.org/menu/MemberCenter/SectionsForums/SACP/Resources.a
spx (accessed 2013 Apr 30).
Wilson AL. Financial management for health-system pharmacists. Bethesda,
MD: American Society of Health-System Pharmacists. 2009
http://www.ashp.org/DocLibrary/Bookstore/P881/FirstPages.aspx (accessed
2013 Apr 26).
Pharmacy
Rough SS, McDaniel M, Rinehart JR. Effective use of workload and productivity
efficiency and monitoring tools in health-system pharmacy, part 1.
skill mix
Am J Health-Syst Pharm. 2010; 67:300-11.
Rough SS, McDaniel M, Rinehart JR. Effective use of workload and productivity
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monitoring tools in health-system pharmacy, part 2.
Am J Health-Syst Pharm. 2010; 67:380-8.
American Society of Health-System Pharmacists (ASHP). Practice Resources.
Pharmacy Business Management Resources: Productivity and Benchmarking.
Bethesda, MD:ASHP.
http://www.ashp.org/menu/MemberCenter/SectionsForums/SPPM/Resources.
aspx (accessed 2013 Apr 26).
Working with Consultants
Working with consultants is part of the continuum of knowledge, skills, and abilities that the
pharmacy manager needs to effectively work with senior health system management (the CSuite). Senior management may employ consultants to address issues that require specific
expertise or have a wide impact and require a focused effort. Consultants are employed by
senior management and their perspective on pharmacy will carry over in how they respond to
consultant recommendations.
The most effective strategy to working with consultants is to be proactive and work with senior
management on a long-term basis. (See PPMI C-Suite Resources Web Site Webinar by Tom
Woller , “Effectively Working with External Consultants: A Primer for Pharmacy Directors”.) It is
the pharmacy manager’s responsibility to ensure that senior management understands and
supports pharmacy programs and services based on the value that they bring to patient care.
The pharmacist’s role has also increased based on evidence that the pharmacist contributes to
better patient outcomes and increased safety of medication use. (Giberson S et al. Improving
Patient and Health System Outcomes through Advanced Pharmacy Practice. A Report to the US
Surgeon General 2011) For example, in the inpatient setting the pharmacist is part of the health
care team performing medication histories, participating in rounds, assessing all medication
orders for appropriateness and effectively changing therapy, resolving other medication
therapy issues, responding to drug information queries and educating the patient on discharge
medications. In addition, particularly in the ambulatory care setting, establishing collaborative
practice programs has shifted some prescribing responsibility from the physician to the
pharmacist resulting in improved outcomes of care and often increasing clinic throughput, both
resulting in decreased cost.
The expansion in pharmacists’ roles has increased the number of pharmacists and pharmacy
support staff needed to accommodate increase patient volumes or care responsibility shifted
from physician providers. While the addition of information technology and automation has
increased medication safety and efficiency of some services it has also added to staffing
requirements to support those technologies. The pharmacist’s role in overseeing the formulary
for computerized prescriber order entry (CPOE), bar code medication administration and smart
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infusion pumps, and supporting the creation of decision support rules that support safe
medication use are essential but did not exist in many health systems in the past. (There has
been dramatic growth in health information technology the last five years, for example as
electronic medical record and other patient safety technology use has increased). These
changes may or may not have been part of the senior health system manager’s experience
when they were in training or in their previous position. Senior managers may have limited
experience with pharmacy. It is incumbent on the pharmacy manager to provide information
to senior managers on contemporary pharmacy services and how they contribute to total cost
management, reduce adverse drug events, and improve patient outcomes. Department tours,
face-to-face discussions, short briefing documents, and examples of “good catches” by
pharmacists all can contribute to better awareness of the pharmacy department’s role beyond
managing drug expenses.
When a consultant’s pharmacy services recommendations are received, pharmacy
management may need to provide additional information to senior management so they can
critically evaluate the consultant's recommendations. In many cases, pharmacy managers must
respond to data requests, questions, and proposed recommendations in a timely manner.
Consultants may tend to focus more on personnel expenses rather than drug expenses,
believing that personnel expenses are more controllable by pharmacy management than drug
expenses that are more dependent on prescribers’ clinical decisions. It is important to ensure
that any proposed personnel cost reductions will not raise health care costs in other areas by
increasing patient lengths of stay or re-admissions, increasing adverse drug events, or
increasing drug expenses, for example. This document brings together resources pharmacists
can access when preparing for and working with consultants. It also lists references pharmacists
can use to educate the C-suite and consultants on the important clinical and economic benefits
of pharmacy services.
The PPMI C-Suite Resources site contains more detailed information on working with the CSuite and specifically working with consultants. There are seven sections in the PPMI C-Suite
Resources web site. One of the sections is “Working with Consultants.” It begins with a
presentation by Tom Woller, “Effectively Working with External Consultants – A Primer for
Pharmacy Directors.” This 42-minute presentation provides recommendations on how to work
with external consultants and how to respond to recommendations made by consultants.
Some key points from the presentation are:
•
•
•
•
Understand why the consultant has been engaged.
When you receive a recommendation avoid “we can’t” statements; the key question is whether
you should.
Keep your organization from making bad decisions within your area of expertise.
Always try to drive the discussion to the real bottom line (total cost of caring for the patient).
A second resource in this section is a 2008 article by Michael Sanborn titled “Working
Effectively with Consultants” (Hospital Pharmacy 2008; 43:231-236). This article contains useful
information on:
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•
•
•
•
•
Consultant selection (if that is an opportunity).
Preparation and data collection.
Being an active participant in the consultant engagement.
Development of recommendations.
Implementation of recommendations.
Two articles by Steve Rough, Michael McDaniel and James Rinehart, “Effective use of workload
and productivity monitoring tools in health-system pharmacy. Part 1 and Part 2” (Am J HealthSyst Pharm. 2010; 67:300-11 and 67:380-8) discuss “external and internal workload and
productivity measurement systems and strategies to improve their use to maximize overall
pharmacy department operational performance and staffing effectiveness.”
Other sections of the PPMI C-Suite Resources are useful to pharmacy managers working with
consultants and/or hospital administration, particularly when a long-term, proactive approach
is taken.
•
•
•
•
•
Engaging the C-Suite: Starting the Dialog
Strategic Planning
Managing your Business – this provides several examples of business plans for various
types of services
Health Care Reform and Pharmacy Practice – Includes a presentation titled “The
Pharmacist Role in Improving the Bottom Line.” The presentation discusses the
pharmacist’s role in increasing patient satisfaction as reflected in the HCAHPS program.
General Resources
Using this resource
When a pharmacy manager is asked to answer questions as to whether the cost of pharmacy
services is justified, the manager should review his or her results data as well as pharmacy
studies and best practices to advocate for his or her patients.
Data collected in the health system may be used to validate the value of the service relative to
the cost and may carry the most weight. Having institution-specific data that is consistent with
the evidence in the literature can be extremely valuable. Core Measure data (for example,
Surgical Care Improvement Project (SCIP)), Hospital Consumer Assessment of Healthcare
Providers and Systems (HCAHPS) Survey data, and data on readmissions or length of stay that
may be used to track improvement when new programs with a pharmacist role is important.
For example, data on improvement in HCAHPS data on communication regarding medication
after implementing pharmacist inpatient education on medications prescribed is valuable. See
the PPMI C-Suite Resources site section on “Communicating Results.”
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When faced with a pharmacy personnel budget reduction, usually as part of a multidepartment reduction in force, the pharmacy manager must assess whether the staffing
changes would adversely impact patient care. In some cases, realignment of staffing or crosstraining, a change in skill mix, implementation of innovative service changes, or the use of
technology can be employed to reduce a department's budget without negatively affecting the
quality of patient care.
If the recommendations to reduce the pharmacy personnel budget do not take into account
the bottom line impact on the hospital budget of decreased quality of patient care, risk to safe
medication use, increase in drug expenses, increased length of stay, or increased readmission
rates, for example, then it is incumbent on the pharmacy manager to communicate these
issues. If it is projected that a proposed reduction in pharmacy staff will negatively impact
patient care, then it is essential for a pharmacy manager to identify what the effect will be and
to present data that supports this conclusion. In doing so, the pharmacy manager is presenting
the business case for maintaining pharmacy services best practices.
Case study example
If, for example, if the consultant’s focus is a pediatric unit, the following resources are available
for a pharmacy manager.
1. The PPMI C-Suite Resources section Managing your Business contains a Business Plan Examples,
Business case- Pediatric Operational FTE Justification
(http://www.ashpadvantage.com/ppmitoolkit/docs/Business_Case__Pediatric_Operational_FTE_Justification.docx). While this case is presented from the
perspective of a need to add resources, many of the concepts are applicable to discontinuing or
scaling back services. Applicable concepts include how clinical pharmacists improve patient
outcomes, decrease the cost of treatment, and decrease medication errors. Additional
literature support for these concepts is available in the References section.
a. In the Patient Safety section of References, the recently published Agency for
Healthcare Research and Quality publication “Making Health Care Safer II” reviews
recent literature supporting the role of the clinical pharmacist in improving the quality
and safety of patient care.
b. In the Cost Containment/Cost Effectiveness section, the Chisholm-Burns article
“Economic effects of pharmacists on health outcomes in the United States: A systematic
review” presents the business case for positive economic benefits with pharmacist
interventions.
c. This section also contains Perez's article “Economic Evaluations of Clinical Pharmacy
Services 2001-2005” that presents literature to support $4.81 in reduced costs or other
economic benefits for every $1 invested in clinical pharmacy services.
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2. Other points of support should be identified based on:
a. The specific focus of the service—what won’t be done if the resource is not available.
b. What the dialogue has been with the C-Suite and medical staff leadership. Is safety a
pre-eminent concern? Is patient satisfaction a target for improvement?
c. Are there metrics tracked on the Hospital and/or Pharmacy Dashboard that are
relevant?
Conclusion
Consultants may be engaged by an organization for many reasons. Given the rapidly changing
environment of health care and the continued demand by consumers and payers for higher
quality and reduced expense the use of consultants is expected to continue to grow. Working
with consultants has become a routine component of the job of health care managers and this
requires a skill set and commitment to being prepared for a consultant’s review and
recommendations. Important issues to consider include:
a. Maintaining a service plan that establishes priorities and evolves over time to maximize efficient
use of resources and patient care outcomes.
b. Knowing the literature on best practices.
c. Knowing how you compare to a peer group.
d. Maintaining a data set of outcome data that demonstrates results of strategic decisions (key
elements of this data set should be included in your dashboard that communicates on an
ongoing basis your progress on goals and current status of key indicators).
e. Operating from a team perspective with the primary focus on patient care outcomes.
f. Utilizing a continuous “managing up” education program of senior management and key
stakeholders.
g. Knowing the organizations goals and tactics and how your department contributes to those
goals.
Appendix A provides a checklist of benefits pharmacy services can provide to patient care and
refer to the relevant Reference sections In Appendix B.
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Appendix A
The value of the pharmacist in their health-system role: a checklist
a) Pharmacist clinical role as a member of the health care team improves patient care
outcomes. See Cardiovascular Disease References, Diabetes References, Emergency
Department References, Medication Adherence References, Mental Health References,
Pediatrics references.
b) Pharmacist clinical role managing patient drug therapy can replace or supplement
physician provided care. This can help address the shortage of primary care physicians.
Patient care models can also be established that improve accessibility to care. Reduced
access to primary care can increase hospitalization rates and expenditures. See Access
to Care References, Disease Prevention and Management References, Outpatient Care
References.
c) Pharmacist clinical role as a member of the health care team reduces medication errors
and adverse drug events. See Emergency Department References, Medication
Adherence References, Medication Reconciliation References, Patient Safety
References.
d) Pharmacist role as a member of the health care team reduces length of stay and
pharmacy and hospital costs. See Length of Stay References, Medication Reconciliation
References.
e) Pharmacist role providing inpatient care services results in a financial return and quality
and safety return. See Cost Containment/Cost Effectiveness references.
f) Pharmacists practicing in the medical home model improve patient outcomes. See
Medical Home References.
g) Pharmacists can contribute to programs that improve compliance with CMS Core
Measures. See Quality of Care References, Team-Based Health Care References.
h) Pharmacists can contribute to programs that improve patient satisfaction with CMS
HCAHPS measures, such as medication and pain management. See Quality of Care
References, Team-Based Healthcare References.
i) Pharmacists can contribute to reducing the rate of readmission within 30 days by, for
example, improving medication compliance through patient education and reducing the
number of medication discrepancies upon discharge. See Care Transitions References,
Quality of Care References, Readmission References.
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Appendix B
Working with Consultants References
Access to Care
1.
Cohen LB, Taveira TH, Khatana SA et al. Pharmacist-led shared medical appointments for
multiple cardiovascular risk reduction in patients with type 2 diabetes. Diabetes Educ. 2011;
37:801-12.
2. Giberson S, Yoder S, Lee MP. Improving Patient and Health System Outcomes through Advanced
Pharmacy Practice. A Report to the U.S. Surgeon General. Office of the Chief Pharmacist. U.S.
Public Health Service. Dec 2011. (See Appendix B. Focus Point 4 Evidence- Based Alignment with
Health Care Reform, pages 42-45).
3. American Society of Health-System Pharmacists (ASHP). PPMI C-suite Resources. Managing Your
Business. Business Plan Examples. Business Case - VA Ambulatory Specialist - Women's Health.
American Society of Health-System Pharmacists: Bethesda, MD.
http://www.ashpadvantage.com/ppmitoolkit/resources.html#managing (accessed 2013 May 7).
Cardiovascular Disease
1. Bauer JB, Chun DS, Karpinski TA et al. Pharmacist-led program to improve venous
thromboembolism prophylaxis in a community hospital. Am J Health-Syst Pharm. 2008;
65:1643-7. (PPMI 40)
2. Cohen LB, Taveira TH, Khatana SA et al. Pharmacist-led shared medical appointments for
multiple cardiovascular risk reduction in patients with type 2 diabetes. Diabetes Educ.
2011; 37:801-12.
3. Coons JC, Fera T. Multidisciplinary team for enhancing care for patients with acute
myocardial infarction or heart failure. Am J Health-Syst Pharm. 2007; 64:1274-8.
4. Dager WE. Issues in assessing and reducing the risk for venous thromboembolism. Am J
Health-Syst Pharm. 2010; 67(Suppl 6):S9-16.
5. Dawson NL, Porter IE 2nd, Kilpa D et al. Inpatient warfarin management: pharmacist
management using a detailed dosing protocol. J Throm Thrombolysis. 2012; 33:178-84.
6. Dobesh PP, Phillips KW, Haines ST. Improving the use of anticoagulant therapies in
acutely ill medical patients. Am J Health-Syst Pharm. 2008:65 (Suppl 7):S5-12.
7. Dobesh PP, Trujillo TC, Finks SW. Role of the Pharmacist in Achieving Performance
Measures to Improve the Prevention and Treatment of Venous Thromboembolism.
Pharmacotherapy. 2013 Apr 1. [Epub ahead of print]
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8. Margolis KL, Asche SE, Bergdal AR et al. Effect of Home Blood Pressure Telemonitoring
and Pharmacist management on Blood Pressure Control: A Randomized Clinical Trial.
JAMA. 2013; 310 (1):46-56.
9. Murray MD, Young J, Hoke S et al. Pharmacist intervention to improve medication
adherence in heart failure. Ann Intern Med. 2007; 146:714-25.
10. Nutescu EA. Anticoagulation Management Services: Entering a New Era.
Pharmacotherapy 2010; 30(4):327-9.
11. Santschi V, Chiolero A, Burnand B et al. Impact of pharmacist care in the management of
cardiovascular disease risk factors. Arch Intern Med. 2011; 17:1441-53.
12. Tales of Success in Boosting HCAHPS Scores, Pharmacy Practice News, August 2012.
13. Weber CA, Ernst ME, Sezate GS et al. Pharmacist-physician co-management of
hypertension and reduction in 24-hour ambulatory blood pressure. Arch Intern Med.
2010; 170:1634-9.
14. American Society of Health-System Pharmacists (ASHP). PPMI C-suite Resources. Managing Your
Business. Business Plan Examples. Business Case - Anticoagulation Management Stewardship
Program. American Society of Health-System Pharmacists: Bethesda, MD.
http://www.ashpadvantage.com/ppmitoolkit/resources.html#managing (accessed 2013 May 7).
Care Transitions
1. ASHP-APhA Medication Management in Care Transitions Best Practices. American Society of
Health-System Pharmacists: Bethesda, MD, and American Pharmacists Association: Washington,
DC. 2013 Feb.
http://media.pharmacist.com/practice/ASHP_APhA_MedicationManagementinCareTransitionsB
estPracticesReport2_2013.pdf (accessed 2013 Apr 22).
Cost Containment/Cost Effectiveness
1. Bond CA, Raehl CL. Clinical and economic outcomes of pharmacist-managed
aminoglycoside or vancomycin therapy. Am J Health-Syst Pharm. 2005; 62:1596-605.
2. Boyko WL Jr, Yurkowski PJ, Ivey MF et al. Pharmacist influence on economic and
morbidity outcomes in a tertiary care teaching hospital. Am J. Health-Syst Pharm. 1997;
54:1591-5.
3. Chisholm-Burns MA, Graff Zivin JS, Lee JK et al. Economic effects of pharmacists on
health outcomes in the United States: A systematic review. Am J. Health-Syst Pharm.
2010; 67:1624-34.
4. Dobesh PP Phillips KW, Haines St. Improving the use of anticoagulant therapies in
acutely ill medical patients. Am J Health-Syst Pharm. 2008:65 (Suppl 7):S5-12.
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5. Finley PR, Bluml BM, Bunting BA et al. Clinical and economic outcomes of a pilot project
examining pharmacist –focused collaborative care treatment for depression. J Am
Pharm Assoc. 2011; 51:40-9.
6. Giberson S, Yoder S, Lee MP. Improving Patient and Health System Outcomes through
Advanced Pharmacy Practice. A Report to the U.S. Surgeon General. Office of the Chief
Pharmacist. U.S. Public Health Service. Dec 2011. (See Appendix B. Focus Point 4
Evidence- Based Alignment with Health Care Reform (pages 36-41).
7. Perez A, Doloresco F, Hoffman JM et al. ACCP: Economic evaluations of clinical
pharmacy services 2001-2005. Pharmacotherapy. 2009. 29:128.
8. Ramalho de Oliveira D., Brummel AR, Miller DB. Medication therapy management: 10
years of experience in a large integrated health care system. J Manag Care Pharm. 2010;
16:185-95.
9. Vermeulen LC, Rough SS, Thielke TS et al. Strategic approach for improving the
medication-use process in health systems: The high-performance pharmacy practice
framework. Am J Health-Syst Pharm. 2007:64:1699-710.
Diabetes
1. Cohen LB, Taveira TH, Khatana SA et al. Pharmacist-led shared medical appointments for
multiple cardiovascular risk reduction in patients with type 2 diabetes. Diabetes Educ. 2011;
37:801-12.
2. Yoder VG, Dixon DL, Barnette DJ et al. Short-term outcomes of an employer-sponsored diabetes
management program at an ambulatory care pharmacy clinic. Am J Health-Syst Pharm. 2012.
69:69-73.
Disease Prevention and Management
1. Giberson S, Yoder S, Lee MP. Improving Patient and Health System Outcomes through
Advanced Pharmacy Practice. A Report to the U.S. Surgeon General. Office of the Chief
Pharmacist. U.S. Public Health Service. Dec 2011. (See Appendix B. Focus Point 4
Evidence- Based Alignment with Health Care Reform (page 36-41).
Emergency Department
1. Aldridge VE, Park HK, Bounthavong M et al. Implementing a comprehensive, 24-hour
emergency department pharmacy program. Am J Health-Syst Pharm. 2009. 66:1943-7.
2. Brown JN, Barnes CL, Beasley B et al Effect of pharmacists on medication errors in an
emergency department. Am J. Health-Syst Pharm. 2008; 65:330-3.
3. Ernst AA, Weiss SJ, Sullivan A 4th et al. On-site pharmacists in the ED improve medical
errors. Am J Emerg Med. 2012; 30:717-25.
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4. Lada P and Delgado JR. G. Documentation of pharmacists’ interventions in an
emergency department and associated cost avoidance. Am J Health-Syst Pharm. 2007;
64:63-8.
5. American Society of Health-System Pharmacists (ASHP). PPMI C-suite Resources.
Managing Your Business. Business Plan Examples. Business Case - VA Emergency
Department Pharmacist Program. American Society of Health-System Pharmacists:
Bethesda, MD. http://www.ashpadvantage.com/ppmitoolkit/resources.html#managing
(accessed 2013 May 7).
Investigational Drug Services
1. American Society of Health-System Pharmacists (ASHP). PPMI C-suite Resources. Managing Your
Business. Business Plan Examples. Business Case - Investigational Drug Service. American Society
of Health-System Pharmacists: Bethesda, MD.
http://www.ashpadvantage.com/ppmitoolkit/resources.html#managing (accessed 2013 May 7).
Length of Stay
1. Boyko WL Jr, Yurkowski PJ, Ivey MF et al. Pharmacist influence on economic and
morbidity outcomes in a tertiary care teaching hospital. Am J. Health-Syst Pharm. 1997;
54:1591-5.
2. Dobesh PP, Phillips KW, Haines ST. Improving the use of anticoagulant therapies in
acutely ill medical patients. Am J Health-Syst Pharm. 2008; 65 (Suppl 7):S5-12.
3. Kaboli PJ, Hoth AB, McClimon BJ et al. Clinical pharmacists and inpatient medical care: a
systematic review. Arch Intern Med. 2006; 166:955-64.
Medication Adherence
1. Al-Rashed SA, Wright DJ, Roebuck N et al. The value of inpatient pharmaceutical
counseling to elderly patients prior to discharge. J Clin Pharmacol. 2002; 54:657-64.
2. Chisholm-Burns MA, Kim Lee J, Spivey CA et al. US pharmacists' effect as team members on
patient care: systematic review and meta-analyses. Med Care. 2010; 48:923-33.
3. Kaboli PJ, Hoth AB, McClimon BJ et al. Clinical pharmacists and inpatient medical care: a
systematic review. Arch Intern Med. 2006; 166: 955-64.
4. Murray MD, Young J, Hoke S et al. Pharmacist Intervention to Improve Medication
Adherence in Heart Failure. Ann Intern Med. 2007; 146:714-25.
Medication Reconciliation
1. Lo L, Kwan J, Fernandes OA et al. “Chapter 25. Medication Reconciliation Supported by
Clinical Pharmacists (NEW).” In Making Health Care Safer II. Agency for Healthcare
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Research and Quality. March 2013. http://www.ahrq.gov/research/findings/evidencebased-reports/patientsftyupdate/ptsafetyIIchap25.pdf (accessed 2013 Apr 26).
2. Musgrave CR, Hoth AB, McClimon BJ et al. Improving Transplant Patient Safety Through
Pharmacist Discharge Medication Reconciliation. Am J Transplant. 2013; 13:796-801.
3. Ramalho de Oliveira D., Brummel AR, Miller DB. Medication therapy management: 10
years of experience in a large integrated health care system. J Manag Care Pharm. 2010;
16:185-95.
4. Schnipper JL, Kirwin JL, Cotugno MC et al. Role of pharmacist counseling in preventing
adverse drug events after hospitalization. Arch Intern Med. 2006; 166: 565-71.
Medical Home
1. Choe HM, Farris KB, Stevenson JG et al. Patient-centered medical home: Developing,
expanding, and sustaining a role for pharmacists. Am J Health-Syst Pharm. 2012;
69:1063-71.
2. Daigle LA, Banek K. Pharmacists’ MTM Services Key to Health Care Homes’ Success.
2009 Mar. http://www.ashp.org/DocLibrary/News/Health_Care_Home.pdf (accessed
2013 Apr 22).
3. Moczygemba LR, Goode JR, Gatewood SBS et al. Integration of collaborative medication
therapy management in a safety net patient-centered medical home. J Am Pharm Assoc.
2011;
51:167-72.
4. Smith M, Bates DW, Bodenheimer T et al. Why Pharmacists Belong in the Medical
Home. Health Affairs. 2010; 29:906-12.
Mental Health
1. Finley PR, Bluml BM, Bunting BA et al. Clinical and economic outcomes of a pilot project
examining pharmacist –focused collaborative care treatment for depression. J Am Pharm Assoc.
2011; 51:40-9.
Outpatient Care
1. Murray MD, Young J, Hoke S et al. Pharmacist intervention to improve medication adherence in
heart failure. Ann Intern Med. 2007; 146:714-25.
Patient Safety
1. Brown JN, Barnes CL, Beasley B et al Effect of pharmacists on medication errors in an
emergency department. Am J. Health-Syst Pharm. 2008; 65:330-3.
2. Ernst AA, Weiss SJ, Sullivan A 4th et al. On-site pharmacists in the ED improve medical
errors. Am J Emerg Med. 2012; 30:717-25.
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outcomes in a tertiary care teaching hospital. Am J. Health-Syst Pharm. 1997; 54:1591-5.
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Public Health Service. Dec 2011. (See Appendix B. Focus Point 4 Evidence- Based Alignment with
Health Care Reform (page 36-41).
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adverse drug events in hospital general medical units. Arch Intern Med. 2003; 163:2014-8.
8. Leape LL, Bates DW, Cullen DJ et al. Pharmacist participation on physician rounds and adverse
drug events in the intensive care unit. JAMA. 1999; 282: 267-70.
9. Santschi V, Chiolero A, Burnand B et al. Impact of Pharmacist Care in the Management of
Cardiovascular Disease Risk Factors. Arch Intern Med. 2011; 17:1441-53.
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process in health systems: The high-performance pharmacy practice framework. Am J HealthSyst Pharm. 2007:64:1699-710.
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2. Sokos DR, Skledar SJ, Ervin KA et al. Designing and implementing a hospital-based vaccine
standing orders program. Am J Health-Syst Pharm. 2007; 64:1096-102.
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