Abstract:

Objectives:
Most APPEs occur from 4-6 weeks, allowing a narrow window for students to feel comfortable and confident in their clinical responsibilities before moving on. This affects their ability to accurately and completely document clinical interventions. Our objective was to conduct an economic analysis of clinical interventions documented during an integrated 12 week APPE model compared to previous non-integrated APPE data and to quantify value added to students, preceptors and institutions with this model.

Methods:
A 6 week ambulatory care (AC) and internal medicine (IM) APPE were integrated into a longitudinal 12 week APPE comprised of a fluid structure where students transitioned from inpatient to outpatient services multiple times within the 12 week structure and increased student exposure to patients transitioning from inpatient to outpatient care. Clinical intervention documentation was required via a web-based system and data from the integrated APPE was compared to previous students from each preceptor from stand-alone AC and IM rotations at the same hospital. Specific comparisons included compare adverse drug events (ADEs) and medication errors (MEs) prevented, as well as an economic evaluation to assign cost savings associated with these data.

Results:
Twelve integrated APPE students documented 1984 interventions vs. 873 from 12 students completing separate APPEs with the same preceptors (p <0.001). Intervention categories remained consistent with a significant increase in medication histories performed (11.5% to 18.3%) and intervention level of significance increased in the integrated model. 1053 ADEs were prevented (936 integrated vs. 117 pre-integration, p<0.001) associated with a total cost savings of $332, 985. Similarly, 274 MEs were prevented (168 integrated vs. 108 pre-integration, p=0.07) associated with a cost savings of $34, 012. This averages $26, 403 cost savings per student in the integrated model vs. $4086 pre-integration (p<0.001) over a 12 week period.

Conclusion:
An integrated APPE decreases orientation time for students and preceptors, increases interactions with patients, increases clinical intervention documentation and results in increased prevention of ADEs and MEs, resulting in increased cost savings.

Keywords:

Integrated pharmacy rotation, clinical intervention, economic analysis.