EPIC – a Chronic Disease Management Initiative in

BC

EPIC – a Chronic Disease Management Initiative in

BC

Barbara Ogle, BSc(Pharm), ACPR, MScPhm, RPhVP Clinical Services, Network Healthcare

May 31, 2007

Barbara Ogle, BSc(Pharm), ACPR, MScPhm, RPhVP Clinical Services, Network Healthcare

May 31, 2007

Network Healthcare

Network Healthcare• A health services company that supports the

development & delivery of health care through sophisticated networks of clinical professionals.

Pharmacist Network• A service delivery arm of Network

Healthcare that utilizes pharmacists to deliver care to patients.

Network Healthcare• A health services company that supports the

development & delivery of health care through sophisticated networks of clinical professionals.

Pharmacist Network• A service delivery arm of Network

Healthcare that utilizes pharmacists to deliver care to patients.

Uninformed,PassivePatient/

Caregivers

FrustratingProblem-Centered

Interactions

UnpreparedPractice Team

SystemDesign

•Reliance on short, unplanned visits

Decision Support

•No agreement on good care

•Traditional referrals

ClinicalInformation

Systems•Don’t know

patient or their needs

Self-Management

Support•Not systematic•Didactic

CURRENT HEALTH SYSTEM

Resources & PoliciesNo links to communityagencies or resources

Community Health Care Organization•Concern about the bottom line•Incentives favor more frequent, shorter visits•No organized QI

Sub-optimalFunctional and Clinical Outcomes

Chronic Disease Management in British Columbia > 50% of BC health care budget goes to

the 10% of people with chronic diseases Ministry of Health’s response

• Adopted the Expanded Chronic Care Model and Patient Self-Management

• Used Primary Health Care Transition Funds for strategic initiatives focused on high-risk, high-cost CDM patients

> 50% of BC health care budget goes to the 10% of people with chronic diseases

Ministry of Health’s response• Adopted the Expanded Chronic Care

Model and Patient Self-Management

• Used Primary Health Care Transition Funds for strategic initiatives focused on high-risk, high-cost CDM patients

Expanded Chronic Care Model

EPIC

Empowering Patients through Integrative Care

Business Need

Expand the primary care team where gaps exist (pharmacist)

Increase system capacity to meet periodic needs of patients for more intense support

Increase access to timely support between appointments and where rural or individual barriers to service exist

Expand the primary care team where gaps exist (pharmacist)

Increase system capacity to meet periodic needs of patients for more intense support

Increase access to timely support between appointments and where rural or individual barriers to service exist

Goal

To develop and evaluate the feasibility of a telehealth model for pharmacists to provide self-management and medication management support to people with diabetes or heart failure in collaboration with primary healthcare teams.

To develop and evaluate the feasibility of a telehealth model for pharmacists to provide self-management and medication management support to people with diabetes or heart failure in collaboration with primary healthcare teams.

Objectives

Increase patient self-efficacy and self-management with medications

Improve attainment of desired drug therapy outcomes

Improve medication safety

Increase patient self-efficacy and self-management with medications

Improve attainment of desired drug therapy outcomes

Improve medication safety

Pharmacist Intervention

Community pharmacist as virtual member of health team

Provide telehealth coaching, information and self-management support for up to 6 weeks

Identify, prevent and/or manage potential and actual drug-related problems

Provide clinical decision support to the family physician and primary healthcare team

Facilitate transition to community resources (e.g., community pharmacist, local groups)

Community pharmacist as virtual member of health team

Provide telehealth coaching, information and self-management support for up to 6 weeks

Identify, prevent and/or manage potential and actual drug-related problems

Provide clinical decision support to the family physician and primary healthcare team

Facilitate transition to community resources (e.g., community pharmacist, local groups)

Project Details

Timeline• Planning 2004• Pilot Testing 2005• Data Collection 2005 – 2006

Team• BC Ministry of Health• BC NurseLine• Pharmacist Network BC• University of Victoria – Centre on Aging• Fraser Health Authority• Northern Health Authority

Timeline• Planning 2004• Pilot Testing 2005• Data Collection 2005 – 2006

Team• BC Ministry of Health• BC NurseLine• Pharmacist Network BC• University of Victoria – Centre on Aging• Fraser Health Authority• Northern Health Authority

Patient Findings (n = 201)

Learned self-management skills Resolved drug-related problems Became more engaged in their own care Improved health status Liked having telehealth in their own

home, interpreters and flexible times Regular follow-up kept patients focused

Learned self-management skills Resolved drug-related problems Became more engaged in their own care Improved health status Liked having telehealth in their own

home, interpreters and flexible times Regular follow-up kept patients focused

Physician Findings (n = 112)

Collaborative interactions observed Electronic lab data accessed for some Telehealth was economical, scalable,

and sustainable Follow-up extended beyond practice

• Focus on patient self-management filled existing care gap

Collaborative interactions observed Electronic lab data accessed for some Telehealth was economical, scalable,

and sustainable Follow-up extended beyond practice

• Focus on patient self-management filled existing care gap

Other Research

Impact of medication therapy discontinuation on mortality after MI• Endpoints: use of aspirin, β blockers and

statins at 1 month; mortality @ 12 months

• >33% had stopped one or more medications

• 12.1% had stopped all three• Poorer 1-year survival than those persisting

88.5% vs 97.7%, p<0.001

• Risk factors include age and education

Impact of medication therapy discontinuation on mortality after MI• Endpoints: use of aspirin, β blockers and

statins at 1 month; mortality @ 12 months

• >33% had stopped one or more medications

• 12.1% had stopped all three• Poorer 1-year survival than those persisting

88.5% vs 97.7%, p<0.001

• Risk factors include age and education

PM Ho et al. Arch Intern Med 2006;166:1842-1847.

Other ResearchOther Research

Drug-related hospitalizations in a tertiary care internal medicine service• n=565 adult patients admitted to hospital

• Drug-related 24.1% (95% CI 20.6-27.8%)– Adverse drug reactions 35.3%

– Improper drug selection 17.6%

– Noncompliance 16.2%

• Majority of cases were preventable• 72.1% (95% CI 63.7-79.4%)

Drug-related hospitalizations in a tertiary care internal medicine service• n=565 adult patients admitted to hospital

• Drug-related 24.1% (95% CI 20.6-27.8%)– Adverse drug reactions 35.3%

– Improper drug selection 17.6%

– Noncompliance 16.2%

• Majority of cases were preventable• 72.1% (95% CI 63.7-79.4%)

Samoy LJ et al. Pharmacotherapy 2006;26:1578-86.

Other Research

Effectiveness of telephone counselling by a pharmacist in reducing mortality in patients receiving polypharmacy• RCT, n=502 non-compliant pts

• 6-8 telephone calls between visits

• Polypharmacy = 5 or more medications

• Endpoint: all-cause mortality in 2 years• ARR 6% (17% control vs 11% intervention)

• RRR 41% (95% CI 0.35-0.97, p=0.039)

• NNT to prevent 1 death = 16

Effectiveness of telephone counselling by a pharmacist in reducing mortality in patients receiving polypharmacy• RCT, n=502 non-compliant pts

• 6-8 telephone calls between visits

• Polypharmacy = 5 or more medications

• Endpoint: all-cause mortality in 2 years• ARR 6% (17% control vs 11% intervention)

• RRR 41% (95% CI 0.35-0.97, p=0.039)

• NNT to prevent 1 death = 16

JYF Wu. BMJ  2006;333:522, doi:10.1136/bmj.38905.447118.2F

Compared to…

Statin therapy• Based on 2003 Canadian guidelines

• NNT to prevent 1 death due to CHD over 5 years for high risk* Canadians is 98

• Canadian statin market = $1.4B

Statin therapy• Based on 2003 Canadian guidelines

• NNT to prevent 1 death due to CHD over 5 years for high risk* Canadians is 98

• Canadian statin market = $1.4B

*10-year risk of CHD ≥ 20%, or history of CVD or diabetes with age > 30 yrs

Going Forward

BC Alberta Service Development

• SAFERx (real world safety & effectiveness)• Seamless Medication Care• Chronic Disease Management (medication

management and self-management support)• Medication Reviews and Assessments• Emergency Preparedness

BC Alberta Service Development

• SAFERx (real world safety & effectiveness)• Seamless Medication Care• Chronic Disease Management (medication

management and self-management support)• Medication Reviews and Assessments• Emergency Preparedness

The ‘Innovation’ Challenge

Contact Information

Barbara Gobis Ogle,

Vice President, Clinical Services

Network Healthcare

bogle@networkhealthcare.ca

604-231-3245