Implementation of an Enhanced Medication Access Workflow within a Health System Specialty Pharmacy: Impact on Patient & Clinician Experience

Abstract

ABSTRACTPurposeThe initiation of specialty medications is associated with patient access challenges and clinician burden. This intervention invested resources upstream of the prescription being written. The evaluation assessed the impact on patient and clinician experience.MethodsThe specialty pharmacy intervention was designed to improve medication access within five medical specialty clinics by utilizing an embedded medication access team assigned to patients and prescribers of targeted medications. We used a multi-methods evaluative approach. Semi-structured qualitative interviews provided an understanding of clinician experience. To quantitatively assess associations between the referral process and patient experience, we analyzed the emotional valence of patient portal messages using a retrospective cohort study and an event study framework of a non-randomized, stepped wedge implementation design.ResultsThe intervention was associated with an increase in the net positive emotional valence of patient portal messages (AME, 5.3; 95% CI, 3.8-6.8). Except for gastroenterologists seeing patients for irritable bowel disease, patients cared for in all other specialties experienced statistically significant increases in net positive valence in the primary analysis. Regarding clinician experience, four major interrelated themes emerged from 17 qualitative interviews with prescribers and pharmacists: (1) decreased clinician burden, general praise, (2) improved experience & satisfaction, reduced anxiety & concerns, (3) rewarding praise for other prescribers/colleagues, and (4) excellent coordination, efficiency, and speed.ConclusionInvesting staff resources before, during, and after the prior authorization process greatly improves clinician experience. The positive valence of patient portal messages also increased suggesting patient experience improvements.