Beyond the call: Implementing a patient-first digital refill solution in a health-system specialty pharmacy

Health-system specialty pharmacies (HSSPs) play a critical role in optimizing medication management for patients with complex conditions. To improve refill workflow efficiency, enhance the patient experience through digital refill self-management, and reduce administrative burden, the Specialty Pharmacy Assessment for Refills-Questionnaire (SPAR-Q) was implemented as an alternative to Specialty Pharmacy Assessment for Refills-Live (SPAR-L) telephone-based outreach. This report describes the design, integration, implementation, and outcomes of the SPAR-Q in an HSSP setting.

The SPAR-Q was designed to streamline refill assessments by transitioning eligible patients to a digital questionnaire accessible through the electronic medical record (EMR) patient portal. The questionnaire captured adherence, medication effectiveness, and potential barriers, with automated pharmacist escalation for flagged responses. Following a phased rollout from June to November 2023, the SPAR-Q achieved sustained patient engagement during routine operations (December 2023 to November 2024), with 14,325 responses (38.32% response rate). Implementation significantly reduced technician workload by approximately 2,185 hours annually (equivalent to 1.05 full-time employees). Pharmacist escalation was necessary for 31.9% of responses, primarily due to new medications (24.5%), missed doses (17.7%), and new medical conditions (16.7%). The SPAR-Q also facilitated more precise patient-reported medication effectiveness ratings compared to telephone-based assessments.

The SPAR-Q successfully streamlined refill management processes, enhanced patient convenience, and reduced administrative burdens while preserving essential pharmacist clinical oversight. Continued optimization efforts should focus on refining automation, expanding patient education, and further evaluating clinical and patient satisfaction outcomes to maximize the impact of digital-first refill management solutions.