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Optimizing finite resources: Pharmacist chart reviews in an outpatient kidney transplant clinic.

OBJECTIVE
To determine if a pharmacist-executed comprehensive chart review could serve as sufficient substitution for direct participation during outpatient clinic visits in the postdischarge follow-up treatment of kidney transplant recipients.


DESIGN
Retrospective, longitudinal, cross-sectional study.


SETTING
Acute and chronic transplant clinics at the Medical University of South Carolina, Charleston, SC.


PARTICIPANTS
219 individual kidney transplant recipients.


MAIN OUTCOME MEASURES
Effectiveness of chart review assessments (with written notes) as compared with in-clinic assessments (with verbal communication with transplant providers followed by documentation by pharmacists). An independent transplant provider graded pharmacist recommendations by severity. All recommendations were compared with the provider's plan to determine if the recommendations were incorporated.


RESULTS
During the 3-month study period, 170 pharmacist chart reviews were written and 175 clinic visits involved direct pharmacist participation. Providers accepted a greater percentage of recommendations that were delivered directly compared with recommendations presented via a note in the patient folder following chart review (92% vs. 28%, respectively; P <0.0001). Directly provided recommendations were also associated with higher severity scores.


CONCLUSION
The results of this study suggest that comprehensive chart review by pharmacists prior to patient clinic visits may not be as effective as in-person consultation in communicating recommendations to providers. Further research is needed in similar clinic settings.