Assessment of the Clinical Pharmacy Practice Models for Provision of Pharmaceutical Care at The Hospital for Sick Children. Phase 1: A Narrative Review of Clinical Pharmacy Practice Models

Abstract

Background: Clinical pharmacy practice models (CPPMs) determine how a pharmacy department allocates resources for the provision of clinical pharmacy services by clinical pharmacists. Based on available published literature, there is a lack of consensus on CPPMs. Objective: A narrative review was performed to identify current CPPMs and inform future phases of this initiative. This narrative review aimed to provide insight for services and/or metrics included in general or service-specific clinical pharmacy practice models. Methods: Literature searches were conducted using MEDLINE, EMBASE, IPA, and Scopus by the resident and librarians independently and confirmed that there was no published consensus on CPPMs. Additional articles were identified through hand searching, article references, and grey literature. Due to limited published articles on CPPMs, a narrative review was conducted instead of a systematic review or scoping review. Articles that discussed any aspect related to allocation of pharmacy resources for pharmacy practice in an inpatient setting were included. Articles were excluded if there was no description of pharmacy model/practice, occurred in an ambulatory/emergency/telehealth/outside of hospital setting, was a survey, or no full text available. Practice model descriptors on type of services (domains) and/or clinical pharmacy key performance indicator (cpKPI) metrics (indicators) were extracted from included articles if available. A total of 701 articles were identified from the literature searches, where 112 articles received full text screening, and 24 articles met inclusion criteria. Results: Included CPPMs varied in their delivery and allocation of pharmacy practice. None of the 24 included articles fully described the domains or indicators. The domain most described was pharmaceutical care (n=20), which described various pharmacist responsibilities such as resolving drug therapy problems (DTPs), participating in rounds, medication reconciliation, and medication education. Indicators that were commonly described were direct patient care (n=4), which described pharmacists performing proactive patient chart reviews, and resolving DTPs(n=8). Overall, included articles included more descriptions of domains, and were less likely to include indicators. Conclusion: The review confirmed that published CPPMs comprised of a variety of different domains and indicators. There is no CPPM that contained entire spectrum of domains or cpKPI metrics. This narrative review was mainly limited by missing information on domains and indicators in included articles. Future studies include creating consensus metrics to evaluate CPPMs and conducting internal/external site surveys as an environmental scan of other hospital CPPMs.