(1391) Impact of Pharmacist Integration Into Post-ICU and Post-COVID Pulmonology Clinic

Introduction: The lOng covid/PosT-Icu MultidisciplinAry cLinic (OPTIMAL) Clinic was created May 2020 in the UCSF Pulmonology Clinic to support patients with PICS and Long COVID. In June 2022, a clinical pharmacist was integrated into clinic to support PICS, long COVID, and high risk Pulmonology patients. The purpose of this study is to determine the financial and clinical impact of incorporating a pharmacist into clinic.

Methods: This is a single center, pre-post, retrospective cohort study conducted between June 1, 2020 and June 30, 2023. The primary outcome evaluated was financial impact, defined as the sum of the gross charged amounts by physicians and a pharmacist providing care in the clinic. Secondary endpoints include number of visits per clinic day, percent no-show appointments, medication reconciliation changes, new medication therapies prescribed, discontinued medications, immunizations administered within 30 days after clinic visit, and 30 day unplanned inpatient and emergency department admission. Statistical analysis includes chi-square test for nominal data and two-sample t-test for normally distributed, continuous data.

Results: A total of 1,745 visits were evaluated; 365 patient visits with pharmacist (WP) and 1,380 without a pharmacist (WOP). The average amount per visit was $269 +/- $250.3 WP vs. $156.2 +/- $195.8 WOP. The average number of patients seen per clinic day was 21.8 +/- 7.4 WP vs. 8.6 +/- 5.1 WOP. No show appointments were 6.5% WP vs. 22.2% WOP. The average number of medication reconciliation changes per visit 13 +/- 10.6 WP vs. 8.6 +/- 10.1 WOP. The average number of new medication orders were 2.7 +/-4.1 WP vs. 0 +/- 0.5 WOP. The average number of discontinued medications per visit was 2.7 +/- 3.6 WP vs. 0.1 +/- 0.6 WOP. There were similar rates of immunizations and 30 day emergency room visits, however 30-day inpatient admissions was 3% WP vs. 4.7% WOP. Projected annual gross revenue WP was $378,020 and costs avoided $1.8 million.

Conclusions: Pharmacist integration in an academic medicine specialty clinic was associated with increased clinic revenue, decreased no show appointments, improved provider productivity, decreased unplanned patient admissions, increased cost avoided and improved medication outcomes.