(Management Case Study) Implementation of a Standardized Pharmacist–Nurse Collaboration to Increase Patient Access for Pharmacist Visits in an Ambulatory Care Setting

Purpose: Our institution currently has over 30 ambulatory care pharmacists practicing in over 50 family medicine and internal medicine clinics. As ambulatory pharmacy services have evolved in our Network over the last 5 years, pharmacist schedule utilization has significantly grown, leading to limited patient access and long wait times for initial appointments with the ambulatory care pharmacist. Ambulatory care pharmacy leadership collaborated with partners in nursing to develop a nursing and pharmacy workflow to enable both disciplines to practice at the top of their license and improve patient access for the pharmacist.

Methods: Our ambulatory pharmacists provide services under a collaborative drug therapy management (CDTM) agreement signed by over 200 primary care providers. Pharmacists are also integral in providing annual wellness visits, transitions of care medication reviews, and COVID treatment evaluations. Medical weight management was added to the pharmacy CDTM in early 2023;and with the popularity of new weight loss medication options, pharmacy referrals for weight management have increased exponentially over the past year. This variety in pharmacy services and unplanned increase in weight management referrals have resulted in well-utilized pharmacist schedules to suddenly struggle with poorer patient access for an initial pharmacist visit. To alleviate the overfull pharmacist schedules, ambulatory care pharmacy leadership partnered with their colleagues in nursing to develop a standardized pharmacist and nurse collaboration for managing patients referred for medical weight management. This collaboration places the nurse as the quarterback of the patient’s care, by completing the initial intake visit and coordinating monthly weight checks throughout the patient’s weight loss journey. In addition, this collaboration simplifies the pharmacists’ role by allowing them to focus on medication management only. Monthly follow up appointments are completed by the nurse and the nurse determines when a follow up with the pharmacist is necessary, for example in cases of adverse effects or cost barriers leading to the need to select an alternative agent.

Results: This multi-disciplinary collaboration was piloted in one primary care office beginning in September 2023 and has resulted in caregivers providing patient care with top of license work. Through transition of monthly weight checks and follow ups to the nurse’s schedule, the pharmacist has been able to open their schedule for additional patient visits. Prior to the implementation of the pilot workflow, the average schedule utilization for the pharmacist was 100% (previous 5 months), with the pharmacist completing 46 weight management appointments. In the seven months post implementation, the pharmacist saw a growth of 220% in weight management appointments (n=147); however, their average schedule utilization dropped to 92%. This drop to a more manageable schedule utilization, despite a significant increase in weight management referrals, allowed for patients to receive care in a timely manner while not overburdening the pharmacist schedule. During the seven months post-implementation, the nurse was able to offload nearly half (n=137) of the total weight management appointments completed. In clinics without this collaborative workflow in place, the pharmacist schedule utilization has increased such that there has not been enough room in the pharmacist’s schedule to adequately meet the patient demand.

Conclusion: Implementation of a pharmacist and nurse collaborative workflow for weight management referrals has resulted in improved patient access for the pharmacist schedule. This workflow allows both disciplines to practice at the top of their license, improves caregiver satisfaction, and decreases wait times for patient’s initial appointments; thus, improving patient and provider satisfaction. The success of this pilot has resulted in expansion of the workflow to additional primary care offices where weight management is in high demand, as well as creating additional pharmacist and nurse collaborative workflows targeting other common chronic conditions, such as hypertension and nicotine dependence.