(Management Case Study) Utilizing Clinical Pharmacy Technicians to Improve Patient Access to Ambulatory Care Pharmacy Services

Purpose: Our institution currently has over 30 ambulatory care pharmacists practicing in over 50 family medicine and internal medicine clinics. As pharmacy services have evolved over the last 5 years, pharmacist schedule utilization has significantly grown leading to the need for more scheduling assistance and support. At this time, individual clinics are limited in the support they can provide our department. Ambulatory care pharmacy leadership identified several opportunities to involve our clinical technicians in enhancing and growing our services. These opportunities include management of pharmacy referrals and scheduling patients in need of a medication review.

Methods: In 2019, our clinical pharmacy technician team was established using medication adherence outcomes to financially justify the positions. Since that time, additional needs within our department have evolved and our technician team has been integral in providing support. To prepare for the work, multiple procedural changes were made. Using modifications to the already existing pharmacy referral in the electronic medical record (EMR), time-sensitive referrals were adjusted to be automatically routed to a newly created referral work queue managed by our team of clinical pharmacy technicians. Non-time-sensitive pharmacy referrals continue to be routed to our Network referral work queue for scheduling. In addition, if a non-time-sensitive referral is not successfully scheduled by the Network scheduling team, there was no formal process in place to capture patients not responding to outreach attempts. In an effort to minimize patients being missed, a new process was developed which includes routing a message to our technicians for improved referral completion. Education and scripting were provided to the clinical pharmacy technicians to discuss with patients the value of an appointment with a pharmacist. Lastly, a process was developed for the technician team to schedule medication therapy management (MTM) appointments with pharmacists during student rotation blocks.

Results: To implement the use of clinical pharmacy technicians, multiple operational support items were created. A pharmacy referral sub-type was added to the referral in the EMR as a required field to guide time-sensitive referrals to our clinical pharmacy technician work queue. New workflows were created for our central referral team to capture patients not responding to automated scheduling outreaches and for scheduling MTM appointments with pharmacists during student rotation blocks.
Since implementation in January 2023, there has been substantial increases in pharmacy services. Our clinical pharmacy technician team has scheduled 260 transitions of care pharmacy appointments which has led to a 41% increase in completed appointments of this type in only 2 months compared to the previous 3 months. The team has scheduled 921 osteoporosis pharmacy appointments in a 2 month period compared to only 102 completed appointments of this type for the entirety of 2022. There have been 225 messages received by our technician pool since implementation of the new workflow for improved referral completion. Lastly, because of the clinical technicians scheduling MTM appointments during the student rotation block, this has led to a 268% increase in completed MTM encounters compared to last year at this time.

Conclusion: Operationalizing changes to processes in our Ambulatory Care Pharmacy department, specifically related to utilization of our clinical pharmacy technician team, has shown increase in patient access to services provided by our clinical pharmacists. We have already seen growth in transitions of care and osteoporosis management appointments, an increase in number of scheduled appointments for completion of non-time-sensitive pharmacy chronic disease management, and an increase in MTM appointments completed by APPE students.