Matthew H. Rim, Pharm.D., M.S., Karen C. Thomas, Pharm.D., Ph.D., DABAT, Brittanie Hatch, Pharm.D., M.S., Thomas J. Davies, Pharm.D., Lauren Holesh, Pharm.D., Michael Kelly, R.Ph., M.B.A., Linda S. Tyler, Pharm,D,, FASHP
University of Utah Health Care, Salt Lake City, UT
Integrated health care services are crucial to patients with multiple chronic diseases. In order to improve the continuum of care for our medically complicated patients, our clinical ambulatory care pharmacy group developed and implemented a highly coordinated centralized comprehensive refill authorization (CCRA) program for multiple community clinics in our health system. The purpose of this program was to implement integrated refill authorization services to provide exceptional patient experience, improve quality of care, and increase the financial strength of the organization.
Before the program implementation, refill authorization requests were handled differently at each of our community clinics with inconsistent turnaround time and staff availability. We started the Pharmacy Ambulatory Clinical Care Center (PAC3) to standardize the refill authorization process, streamline communication, develop robust reporting tools, and increase labor efficiency and clinic capacities. The first step was to centralize the refill request intake process to the PAC3. The second step was to create a workflow in which PAC3 technicians handled all refill requests and administrative functions. The third step was to update our collaborative practice agreement (CPA) to standardize the pharmacist refill approval process and to facilitate appointment scheduling and lab assessments with the nurse triage center. To improve communication with patients, providers, clinic staff, and pharmacies, we developed refill communication procedures and standardized documentation.
We successfully standardized and centralized the medication refill process for our 10 community clinics. Our PAC3 team handles an average of 12,000 refill requests each month and PAC3 pharmacists document all interventions performed with each refill request. The cost savings associated with the CCRA program are attributable to the increased efficiency of the staff reviewing refill requests. We have a dedicated pharmacist and technician staff of 8 full time equivalents (FTEs) addressing all refill requests for our community clinic family practice and internal medicine providers. The previous decentralized model utilized 11 FTEs. The CCRA program increased the refill approval rate by 10% compared with the previous decentralized model. Due to the increased approval rate, the CCRA program saved 510 hours of our providers' time annually, which created an additional 1,530 clinic visits. We also demonstrated a faster average turnaround time, from an average of 72 hours to about one business day.
With the development of our CCRA program, we streamlined refill responsibilities to PAC3 pharmacists and pharmacy technicians. We standardized the method by which refill requests are addressed, increased refill efficiency, and improved our refill authorization turnaround time. We successfully met our goals and developed a well-respected and sought after program within our health system.
