Article Figures & Data
Figures
- Figure 1.
Provider perception of comprehensive medication management impact.
Tables
Characteristic N (%) Gender Female 12 (75) Male 4 (25) Profession Physician 13 (81) Physician assistant 2 (13) Nurse practitioner 1 (6) Years working with a pharmacist providing CMM services Less than 5 9 (56) 5 to 10 7 (44) Greater than 10 0 Years working as a primary care provider Less than 5 3 (19) 5 to 10 2 (13) 11 to 15 3 (19) 16 to 20 1 (6) 21 to 25 3 (19) 26 to 35 2 (13) Greater than 35 2 (13) CMM, comprehensive medication management.
Theme Example Quotation Collaborative partner “I think a lot of the burnout comes from all the multiple decisions you have to make in a day. That can be exhausting. So just again, having someone you can collaborate with on some of those things is great, so I think it reduces burnout. That collaboration absolutely reduces burnout.” (Participant 3) Added skillset and resource “I'll run things by [the pharmacist], med interactions or different questions, so having that resource available makes my job easier and more fulfilling to be able to have someone to ask questions.” (Participant 14) Decreased workload “It does offload some of the work…it's another part of the team helping you take care of your very complicated patients that's equivalent to a provider in terms of their knowledge of medications, if not more; so it really helps take away some of that stress of managing all of those chronically ill patients by yourself. (Participant 12) Satisfaction patients are receiving better care “Just their expertise makes me feel satisfied, because I feel my patients are getting the highest quality [care]. I think it feels so unsatisfying when you don't know something for a patient, so even if I'm not the one solving it for them, to be able to have a resource nearby makes me feel satisfied, because I feel like I can see that my patients are getting quality care even if it's not a hundred percent from me.” (Participant 2) Reassurance “I've been around long enough to see not only burnout as far as a chronic condition, just wearing people down, and you see that, but what you also see is an occasional catastrophic event, lawsuit, loss of license, really horrific things to patients and to providers. I think there's a two-way thing on this and that's part of why I wanted to be able to talk about this openly is the major effect is it reduces that risk.” (Participant 10) Decreased mental exhaustion “A lot of the patients that [CMM] sees are really complex and they need so much time, and they have so much information, and I think it's just even if I could spend the extra time, it just feels like such a mental burden and sometimes an emotional burden, that it feels so nice to either know there's another set of eyes on this patient or oh, this person can handle this one chunk for me.” (Participant 2) Professional learning “I'm constantly learning things from [CMM]. Especially with the diabetes, they're very knowledgeable with all the new things coming out, all the little tricks, or ways to help patients take meds [medications] easier, so I think it plays a lot into compliance. I think it makes me a better doctor, hearing those things as we work together.” (Participant 1) Increased patient access to providers “My patients' biggest complaint is that they can't get in to see me, so being able to see [CMM] and save some other appointments for myself for my more complicated patients is a huge help.” (Participant 14) Achievement of quality measures “We're constantly graded on quality, like are we meeting certain standards for diabetes, high blood pressure, all these things, and having [CMM] as another resource for our patients, another place, another person that can fine-tune some things for us indirectly, helps our quality numbers as a provider, but also our whole clinic when we look at it. To make sure people are reaching their goals that they need to be at number-wise.” (Participant 1) Barriers to CMM “There are sometimes barriers to having [pharmacists providing CMM], like not knowing if patients are covered by them or when patients aren't covered by them [i.e. insurance coverage for CMM services]. But that's not a disadvantage; it's just more of a barrier to care.” (Participant 2) Areas of opportunity “Just [CMM] being here five days a week. Just that consistency would be nice. Then it's a service that you can count on in a way that is predictable.” (Participant 12) CMM, comprehensive medication management.
- Table 3.
Connection between Previously Identified Drivers of Burnout and Impact of CMM on Providers
Seven Drivers of Burnout and Engagement11 Related Theme(s) from Provider Perception of CMM Illustrative Quotation from CMM Interviews Workload and Job Demands Decreased workload
Achievement of quality measures
“Actually, it just gives me another resource for complicated medical management issues for questions about new meds [medications], for questions. I mean, when they're in your care team, it is one other person on your team that helps you take care of the patient. Sometimes I feel like I might get less even questions from nurses, because [the pharmacist] is available for nurses to ask questions to. So it frees me up for other things and makes my day for sure more efficient because they're there to help offload some of the medicine questions, for me as well as for other staff.” (Participant 12) Work-life Integration Decreased workload
Decreased mental exhaustion
“If sometimes we have this chronic condition that we can pass on to [the CMM service] and they can work on that while we're addressing a couple of other things with the patients, that's satisfying, but it also helps us stay moving throughout our day. If we can pass the patient off to them and we can keep seeing other patients and we're not stuck on a particularly problematic issue that we don't really have time for that day, then I get to go home and be with my family and that's really nice. So yeah, they're also very helpful in that situation and that's very good for professional satisfaction.” (Participant 4) Social Support and Community at Work Collaborative partner
Reassurance
“I feel like with [the pharmacist] it's just a nice, really a collegial, kind of … Sometimes we're both doing the same thing, although they know a ton more about the medicines than I do. But I might know more about something else than they, or something; but it's a really collegial sort of sharing, and for me personally, that's fulfilling, and that makes the day nicer and brighter and positive.” (Participant 12) Efficiency and Resources Added skillset/resource
Decreased Workload
Increased provider access
“Again, research has shown in multiple clinical scenarios where a follow up from the clinic helps with these sorts of things, but I can just take that off my plate and trust that it will get done and it will get done well, and in perhaps an easier way for the patient, because they don't necessarily need to come in for a one-on-one visit with me then in addition. They can do that with the [CMM] pharmacist in clinic, or do a phone consultation as well, and not have any more lost time from work for the patient. Again, it's not on my time, after hours, adding to my day.” (Participant 15) Meaning in Work Satisfaction patients are receiving better care
Enhanced professional learning
“Just [the pharmacists'] expertise makes me feel satisfied, because I feel my patients are getting the highest quality. I think it feels so unsatisfying when you don't know something for a patient, so even if I'm not the one solving it for them, to be able to have a resource nearby makes me feel satisfied, because I feel like I can see that my patients are getting quality care even if it's not a hundred percent from me.” (Participant 2) Organizational Culture and Values Our findings do not connect to this driver Control and Flexibility Our findings do not connect to this driver CMM, Comprehensive medication management.
Main Questions Follow Ups How does having MTM available to you affect your day-to-day work? What are some of the advantages of having MTM available to you?
What are some of the disadvantages or limitations of MTM?
What value, if any, does MTM bring to your work as a provider?
How did you decide on where you placed the notecards?
Are there additional notecards that aren't here that should be?
If so, how does the MTM service affect those functions?
We have some notecards here with some common clinical functions or clinical descriptions.* What we'd like you to do is place these notecards on the 0 to 10 scale we gave you–a 10 means having MTM available greatly affects what's on the notecard and a 1 means MTM has no effect. There are no right or wrong answers, we're just curious what your perspectives are. We all know that day-to-day tasks can affect professional satisfaction. Professional satisfaction is often driven by the ability to provide quality care and “includes a high level of [provider] work life satisfaction, a low level of burnout, and a feeling that medical practice is fulfilling.” How does having MTM at your clinic positively and/or negatively affect your professional satisfaction? For example, conversations about medication management may improve some PCP's satisfaction due to their interest in the subject matter, but may decrease some PCP's satisfaction due to the time these conversations take away from their other day-to-day tasks. What are the specific aspects of MTM that affect your job satisfaction?
Are there things MTM is not doing, but could do to increase satisfaction? If so, what?
Now we would like to talk a little bit about burnout. What are the specific aspects of MTM that affect burnout for you?
How has having MTM at your clinic positively and/or negatively affected burnout. Are there things about MTM that could be changed to decrease feelings of burnout? If so, what?
Are there any additional things that you would like to share about MTM services and how the presence of these services affect you and the service you provide to patients? Additional questions if time allows… Suppose you were in charge of the MTM service and could do whatever you wanted to so that MTM reduced PCP burnout. What would you change? [If administrative tasks are brought up]: Let's say we have a pharmacy technician who can complete those administrative tasks. What else would you change?
Notecards read:
Gathering and reviewing information for my patients
Recommending and discussing treatment options with my patients
Documenting my patient visits
Communicating with my patients
Working towards and achieving the clinic's quality improvement initiatives with my patients
Payment the clinic receives for my patients (e.g. RVUs I bill)
Other _______(please fill in the blank)
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