Bryan Bray, Pharm.D., CPPChief Operating OfficerMedication
Management, LLCVice President of Clinical ServicesPiedmont
Pharmaceutical Care Network, LLC
The Prescription for Healthcare Reform: Where are the
Pharmacists?
Highlighting Innovations in Pharmacist-Delivered
CareObjectivesDescribe how comprehensive medication management
services can be provided by a clinical pharmacist embedded within a
physician practice or physically separate.Discuss the involvement
of collaborative drug therapy management.Review the coordinated,
team approach to delivering patient care.Present the quality of
care and outcomes data from the practiceReview the challenges
associated with the practice model.From the Pharmacists
PerspectiveComprehensive Medication Management provided by a
clinical pharmacist embedded into 4 large medical home practices
clinicComprehensive Medication Management provided by a clinical
pharmacist established outside the medical home practice clinic(the
CCNC model)
Embedded ModelPatient-centered, integrated approach with
multi-specialty physicians, nurse practitioners, physicians
assistants, clinical pharmacists and nursesBased on the patients
drug therapy needs, care is delivered by the pharmacist under
collaborative drug therapy managementIntegrated approach whereby
any member of the team may refer a patient to pharmacistElectronic
medical records for documentation that allows for the coordination
of care and clear establishment of patients goals of
therapyReferral ProcessNot for all patients. Identify patients not
meeting therapeutic goalsPatients experiencing drug therapy
problems (ADRs)Patients discharged from the hospitalPatients with
complex medication regimens and have a poor understanding their
regimenPatients with chronic diseases and chronic medication
therapies that require significant self management skills and
educations.Collaborative Drug Therapy ManagementPatient-specific,
evidenced-based driven, outcomes-oriented developed plan of care
for the patient to allow the patient to meet therapeutic
goalsWritten agreement between the physician and the pharmacist to
allow for drug therapy modifications under the supervision of the
physicianAssessment of drug therapy problems and the development of
an individualized medication plan of care with collaborative goals
setPeriodic follow up to address any new medication problems,
measure against goals of therapy and adjust plan of careCareful
coordination with all team members to advise of progress of
patients plan of care with referral process in place
Virtual ModelPharmacist not physically located in the medical
home practiceBroader coordination of care to include traditional
team members and case managersTraditional referral base with
enhanced focus on transition of care patientsOn average, the
patient discharged from the hospital with have 5 medication
discrepancies when comparing the discharge regimen with the home
regimenCoordination of CareSignificant emphasis placed on making
sure the patient with medication related problems on discharge gets
to a primary care provider after discharge for follow
upCommunication of medication related problems between the hospital
provider and the primary care provider to develop the patients plan
of careEfficiency of the team improved, more data with which for
the team to make better decisions in conjunction with the
patientOutcomesPatient specificTraditional clinical such as A1Cs,
INRs within range, BPs, etc.Patient satisfaction with careReduction
in hospital readmissionsOverall, healthcare cost savings (mostly
from reducing hospitalizations and ER visits). Avoid the silo
effect.
OutcomesDiabetes Management31 patients
BaselineYear 4A1C8.6%7.1%% pts with A1C < 9%57%91%% pts with
A1C
