Reducing Primary Care Provider Burnout With Pharmacist-Delivered Comprehensive Medication Management

Abstract

Primary care physicians have among the highest rates of burnout of any medical specialty in the United States. Team-based care is an organizational approach to meet the increasing demands on the primary care system, including the well-being of its providers. Physicians report that pharmacist-delivered comprehensive medication management improves patient care efficiency, decreases workload and provides additional work-based social support, among other benefits. Physician perspectives as well as resources for implementing physician-pharmacist collaborations are discussed.

‘Evidence suggests that team-based care is one organizational approach to meet the increasing demands on the primary care system and reduce physician burnout.’

The prevalence of burnout among physicians in the United States is at an alarming level, and significant differences in burnout have been observed by specialty.¹ Physicians practicing in primary care (general internal medicine and family medicine) have among the highest rates of burnout in the United States.¹ Evidence suggests that team-based care is one organizational approach to meet the increasing demands on the primary care system and reduce physician burnout.^2-4 Pharmacists are from one such discipline that, when added to primary care teams, they improve patient outcomes, patient satisfaction, and health care spending.^4,5 Emerging evidence now demonstrates that physician well-being and burnout may also be improved by adding a pharmacist to the primary care team.^6,7

Physician-Pharmacist Collaboration Impact on Physician Burnout

A recent study interviewed primary care providers (PCPs) to explore how pharmacist-delivered comprehensive medication management (CMM) affects provider work life.⁶ CMM is defined as “the standard of care that ensures each patient’s medications are individually assessed to determine that each medication is appropriate for the patient, effective for the medical condition, safe given the comorbidities and other medications being taken, and able to be taken by the patient as intended.”⁸ A total of 16 PCPs with pharmacists embedded in their clinic providing CMM were interviewed, and themes related to provider burnout were identified, which are discussed in what follows.

PCPs described the pharmacist’s skillset as being “complementary to their own.” Many of the pharmacist’s skills were “time-saving” for PCPs. Specifically, pharmacists could answer or research medication-related questions from the provider or patient more efficiently than other members of the health care team. Likewise, the pharmacist could assist in ensuring that the most cost-effective medications are used. Pharmacists are knowledgeable in prescription drug benefit systems, are familiar with pharmacy-specific benefits such as $4 lists, and can assist in applications for prior authorization or drug manufacturer patient assistance programs. PCPs indicated that these value-added services contributed to their “satisfaction that patients were receiving better care.”

PCPs felt “supported” by pharmacists. Specifically, providers felt “reassured” by the pharmacist’s evidence-based drug knowledge and unique assessment of medication-related problems. PCPs indicated that this detailed history of medication use was helpful when creating a care plan and increased provider confidence in treatment recommendations. This, in turn, “decreased some of the mental exhaustion” of taking care of very complex patients and “enhanced professional learning.”

PCPs reported a “decreased workload” because of a pharmacist embedded on their team. The providers could share some of their patient care, including addressing medication-related patient calls/messages and refill requests. During visits, provider time previously spent on reviewing and educating patients on their medications could now be delegated to the pharmacist. Providers felt that having a pharmacist on their team “increased the patient’s access” to providers because many patients could make medication-specific appointments with the pharmacist directly.

Finally, providers felt that pharmacists increased “achievement of quality measures.” Specifically, pharmacists may provide additional strategies to achieve quality measures and often help PCPs keep track of quality measures and goal attainment.

The study authors connected these findings to a number of drivers of burnout and engagement described by Shanafelt et al⁹:

• Driver 1: Workload and job demands

  • Pharmacists decrease workload and contribute to achievement of quality measures.
• Driver 2: Work-life integration

  • Pharmacists contribute to decreased workload and mental exhaustion.
• Driver 3: Social support and community at work

  • Pharmacists are collaborative partners and provide reassurance on treatment decisions.
• Driver 4: Efficiency and resources

  • Pharmacists provide an added skillset/resource, contribute to decreased workload, and may increase patient access to providers.
• Driver 5: Meaning in work

  • Providers reported increased satisfaction that patients were receiving better care and enhanced professional learning from the unique knowledge-base of the pharmacist.

Although the sample size of the aforementioned study was small and limited research has been conducted examining the effect of a pharmacist providing CMM on PCP well-being and burnout, these findings are supported by a second study of 42 physicians from the UCLA primary care practice system.⁷ A 12-item survey was used to assess physician experiences and satisfaction with clinical pharmacists. In all, 90% of respondents agreed or strongly agreed that having a pharmacist in the office makes management of the patient’s medication more efficient, and 75% agreed or strongly agreed that having a pharmacist as part of the primary care team has made their job easier. Efficiency, workload, and job demands are among the key drivers of physician burnout according to Shanafelt et al.⁹

Physician-Pharmacist Collaboration Resources

Support for physician-pharmacist collaborations is growing. Recently, the American Medical Association developed a StepsForward continuing education module intended to help physicians explore the idea of embedding a pharmacist in their practice.¹⁰ The module outlines a number of suggested roles for an embedded pharmacist:

• Perform preappointment medication reconciliation for the most complex patients.

• Meet with individuals to provide medication education, address barriers to adherence, and answer patient questions.

• Perform medication reviews for high-cost, high-need, and /or complex patients and suggest to the prescribing physician opportunities to improve effectiveness, simplify the regimen, manage drug-drug interactions, improve medication safety, or provide lower-cost alternatives.

• Delegate prescriptive authority by the physician to increase or decrease medications according to agreed-on protocols for common conditions managed in the practice (anticoagulation, blood pressure, diabetes, etc).

The module contains a downloadable tool to aid in determining the pharmacy needs of each practice and assist providers in identifying an appropriate pharmacist partner. Information is also provided to help physicians integrate the pharmacist on the health care team and encourage patients to work with the pharmacist. Logistical issues such as space, workflow, reimbursement, and legal considerations are also discussed.

As evidence-based approaches to addressing provider burnout grow, the role of the pharmacist on the health care team should not be overlooked. As described above, published data demonstrate that physicians find pharmacist-delivered CMM improves patient care efficiency, decreases workload, and provides additional work-based social support.