Hospitals and health systems are increasingly involving pharmacists in inpatient and outpatient care, though many report staffing shortages across different roles and seniorities, according to a newly published industry survey.
Among responses from 250 hospital pharmacy directors polled in fall 2024 by the American Society of Health-System Pharmacists (ASHP), more than three-quarters said pharmacists “routinely” provide clinical services to the majority of their hospital’s inpatients, researchers who conducted the survey wrote in the American Journal of Health-System Pharmacy.
After general medical-surgical (73.3%), they most often reported assignments to critical care (68.5%), oncology (56.9%), cardiology (48.5%), infectious disease/antimicrobial stewardship (48.1%) and the emergency department (46.5%). Those numbers represent “a dramatic rise compared to a decade ago” when, for instance, pharmacist involvement in emergency departments was 10.9%, the association said in a release on the findings.
On the ambulatory side, 71.8% of hospitals that had outpatient clinics reported pharmacists working at those locations, with such reports being more common among larger hospitals.
The pharmacists were most often deployed to anticoagulation (58.4%) and oncology (55.8%) clinics. Among the 47.5% in primary care, family medicine and internal medicine clinics, the pharmacists were most often used to monitor patients’ drug therapy response, adverse events and adherence (85.8%).
Nearly half of hospitals with outpatient clinics also reported using pharmacy technicians to support those operations.
"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 said in a release on the survey findings. "Pharmacists and pharmacy technicians are increasingly part of care models that lead to improved patient outcomes in our healthcare system."
On the other hand, researchers wrote in the report that they found “little or no expansion of either pharmacist prescribing or pharmacy services integration to optimize patient care transitions” compared to survey responses from the past five years. “The lack of growth in pharmacist prescribing may speak to the pharmacist’s role as consultant rather than a primary care provider,” they added.
The researchers and the ASHP release both called out pharmacists and pharmacy technicians increasingly taking on more advanced roles, such as involvement in prior authorizations, 340B Drug Pricing Program compliance, regulatory compliance and technology system management.
As pharmacist and pharmacy technicians become more prevalent in hospital care, personnel shortages hang over many facilities and across various types of roles, according to the survey.
Pharmacy leader shortages were reported among 56.2% of the hospitals, clinical coordinator shortages in 45.4%, clinical specialist shortages in 49.9% and entry-level front-line pharmacists shortages for 30.7%, with rates for the latter two roles increasing substantially since 2022.
Entry-level technician shortages were reported for 64%, experienced technicians for 87.5% and experienced technicians with sterile compounding experience for 92.8%. Hospitals frequently reported using pharmacists to fill empty technician tasks (63.7%).
“In large hospitals, managing drug shortages now requires staff time equivalent to 1.5 full-time employees,” Michael Ganio, the ASHP’s senior director of pharmacy practice and quality and a co-author of the study, said in the association’s release. “That’s a significant resource commitment layered on top of pharmacists’ expanding clinical contributions, and it’s happening at a time when hospital staffing is stressed across the entire care team.”
The ASHP’s National Survey of Pharmacy Practice in Hospital Settings was fielded last fall by email and mail to nearly 1,500 hospital pharmacy directors, with a 16.7% response rate. Researchers weighted the responses to reflect national estimates.