Impact of pharmacy clinical service redesign on quantity and quality of pharmacy interventions in a tertiary teaching hospital: a Pre-Post Cohort Study

Background Pharmacists are integral to the multidisciplinary team; however, staffing and resource challenges limit pharmacists' impact. Aligning pharmacists by specialty, rather than traditional ward-based models, may address these challenges. Aim This study aims to evaluate the impact of a clinical pharmacy redesign on medication reviews. Method The pre-post observational cohort study was conducted at a 550-bed tertiary teaching hospital. The redesign of the clinical pharmacy service was conceived and implemented using redesign methodology. Implemented solutions involved alignment of pharmacists to specialty teams, multidisciplinary teamwork, pharmacist clinical specialisation, an emphasis on clinical documentation, and prioritisation of patients requiring medication review. Pharmacist interventions documented pre- and post-clinical redesign were compared. Two independent reviewers reviewed interventions to classify the type of intervention and determine the impact and significance. Results In total, 226 patients were included in the pre-cohort and 468 post. Age (mean 70 vs 69, p-value = 0.404) and other demographics were similar between the cohorts. Pharmacist interventions increased after the clinical pharmacy redesign (n = 310 vs n = 1,106). After the implementation of the clinical pharmacy redesign, there was a significant increase in the median number of clinical interventions per Full-time Equivalent pharmacist (13.5 [0–64] vs 81.5 [3-166], p = 0.004) despite no change in staffing. The redesign showed a positive impact and increase in all interventions, including Process of care interventions (45.2% vs 57.4%, p-value < 0.001). Conclusion The redesign of pharmacy services increased pharmacist impact without increasing resource requirements or using screening tools, resulting in improved prioritisation of patients, identifying DRPs and increased interventions.