Survey of Health-System Pharmacy Directors Has Mixed Message About Role of Health-System Pharmacists

An annual survey of hospital pharmacists paints a mixed picture of little or no progress toward 2030 goals in some areas while also showing a growing role for pharmacy technicians and pharmacists playing a larger role in other areas, such as anticoagulation and in emergency departments.

In results published today in the American Journal of Health-System Pharmacy, corresponding author Michael C. Ganio, Pharm.D., M.S., of the American Society of Health-System Pharmacists, and his co-authors say the 2024 ASHP National Survey of Pharmacy Practice in Hospital Settings showed little or no expansion of pharmacist prescribing and integration of pharmacy services to improve patient care transitions. Ganio and his colleagues said the growth of advanced analytics, such as the development and implementation of artificial intelligence, machine learning and predictive analytics “has been slower than anticipated.”

Growing role for pharmacy technicians

But the survey authors also highlighted pharmacy technicians taking on activities beyond purchasing, billing and controlled substance management. The new activities include 340B Drug Discount Program management, information technology system management, and responsibilities related to regulatory compliance.

The survey results also showed a large role for pharmacists in anticoagulation therapy that has increased since 2019. The tally of results from the 2024 respondents shows that 63.2% of hospitals have pharmacists routinely manage warfarin therapy: 45.2% have pharmacists manage heparin therapy, and 32.8% have them manage direct oral anticoagulants. The survey showed a great deal of pharmacist involvement in inpatient care. Nearly half (46.5%) of hospitals now assign pharmacists to emergency rooms, an increase from 10.9% in 2011, 18.2% in 2014 and 39% in 2021.

To collect this and other data, Ganio and his colleagues surveyed pharmacy directors at 1,497 general and children’s medical-surgical hospitals in 2024 by email and mail. The response rate was 16.7%, so they had answers from 250 hospitals to work with. The survey covered a wide range of topics and issues, including progress toward American Society of Health-System Pharmacists Practice Advancement Initiative 2030 goals.

Independent prescribing by pharmacists

The 2024 survey showed that inpatient pharmacists independently prescribe medications in 18.5% of hospitals, a decrease from 26.7% in 2023 and 27.1% in 2022. “The lack of growth in pharmacist prescribing may speak to the pharmacist’s role as a consultant rather than a primary care provider,” noted Ganio and his colleagues. “Pharmacists often improve inpatient care using the tools approved by P & T committees to assist in drug selection through consults, therapeutic interchange, and the route of administration changes without needing to independently prescribe.”

The survey also found a decrease in credentialing and privileging activities that can expand the hospital-based pharmacists’ scope of practice. The 2024 survey found that 16% of hospitals had credentialing and privileging systems compared with 22.6% in 2021.

Ganio and his colleagues note that integration of pharmacy services can be a key part of coordinating patient care. Most hospitals (56.2%) reported some integration of services, but a significant minority (28.2%) reported that pharmacy services were not integrated at all. In their conclusion, they remarked that there had been little improvement in transition of care programs. “Achieving full integration of admission, discharge and follow-up processes is a complex task even for highly integrated health systems, and as points of transitions of care expand,” the authors said.

The American Society of Health-System Pharmacists (ASHP) said in a news release that the survey showed that health system pharmacists are playing a larger role in patient care, “reflecting a sharp increase in clinical involvement and more than a decade of steady growth in their roles on the care team.”

“Our survey findings reflect the growing recognition of the critical role pharmacy professionals play on healthcare teams in hospital and health-system settings,” ASHP CEO Paul W. Abramowitz, Pharm.D., said in the news release. “Pharmacists and pharmacy technicians are increasingly part of care models that lead to improved patient outcomes in our healthcare system.”