Methods
For the past 4 years, each PharmD class of approximately 160 students (580 total students participated) were asked to document their clinical interventions during their APPEs in the fourth year of the degree program. Each student completed 10 consecutive 4-week APPEs beginning in May and finishing in April. They were not assigned to an APPE during three 4-week blocks during this year. At least 7 of the 10 APPEs they completed were required patient care APPEs. Patient care APPEs were in ambulatory care practice, inpatient adult medicine or specialty practice, community pharmacy practice, or hospital health-system pharmacy practice.
Prior to beginning their APPEs, students were trained to use Clinical Measures (Elsevier/Gold Standard), a Web-based documentation program purchased by the college. This documentation program was primarily designed for use by health systems as a way of tracking clinical pharmacist interventions on a regular basis. By entering the students' names in as pharmacists and entering the physician's name in place of the practice site, the software was easily modified to collect data on student interventions at any practice site during any APPE. It also did not require patient-specific data to be entered, only information about the specific intervention made. Preceptors were able to check these interventions after the students entered them. The system was reasonably priced (approximately $3500 per year). One of the most impressive features was the ability to generate reports quickly and easily as PDFs that could illustrate student interventions and cost savings. Other similar Web-based systems such as Quntifi and PxDx have been used at other institutions. The documentation program allowed students to enter the type of intervention made and whether it was accepted by the primary health care practitioner. The program would then calculate a cost savings based on the intervention type and the drug involved. A list of available intervention types with major categories and subcategories is available from the author. The software program kept a running total of each student's interventions, the acceptance rates, and the total dollars saved throughout the year. At no time were any patient-specific data collected. Only information regarding the type of clinical interventions made was documented and the associated cost savings were measured. Students were encouraged to document all interventions but were not required to do so. The retrospective evaluation of this student data for publication purposes was submitted to the university's Institutional Review Board and determined to be exempt.
The Clinical Measures program calculated cost savings based on the direct costs that would have been incurred had the potential adverse outcome not been prevented using cost saving/cost avoidance estimates from primary and tertiary literature sources. Clinical Measures also used ProspectoRx to establish drug pricing using the calculated average wholesale price (C-AWP) and average wholesale price (AWP) when the C-AWP was unavailable. For instance, when an intervention, eg, conducting a chart review, was not tied to a specific drug, an hourly rate for pharmacist wages was used and multiplied by the time spent on the activity. (A list of references used for cost verification by the software company is available from the author upon request.)