Attributes of centralized health-system specialty pharmacy clinics: A scoping review using the Donabedian model

Centralized health-system specialty pharmacy (cHSSP) clinics are an emerging model in which pharmacists operate independently from individual specialty clinics and manage the use of specialty medications. As more health systems adopt cHSSP models, there is a need to understand the foundational components that support their effectiveness. This scoping review aimed to identify and synthesize reported structures, processes, and outcomes of cHSSP clinics using the Donabedian model as a guiding framework.

A literature search of PubMed was conducted for primary, peer-reviewed articles published between January 2014 and July 2024. Articles were included if they described US-based cHSSP clinics that operated independently from interprofessional specialty teams and provided clinical services related to specialty medication management.

A total of 24 articles met the inclusion criteria. Structural elements included staffing with ambulatory care-trained pharmacists, use of scheduling assistants and pharmacy technicians, electronic health record access, and varied scopes of pharmacist prescribing authority. Key processes involved benefits coordination, prior authorization, disease state monitoring, adherence counseling, and care coordination. Reported outcomes included improved medication adherence and persistence, patient satisfaction, disease state control, cost containment, and medical provider satisfaction.

This review highlights the variability, adaptability, and promising outcomes associated with cHSSP clinics and provides a foundation for future implementation and evaluation of these models in health systems.