Brian J. Isetts

Becoming ‘Indispensable’: Developing Innovative Community Pharmacy Practices

OBJECTIVE To describe common characteristics of successful innovative community pharmacy practices. DATA SOURCES Four pharmacists who are successfully incorporating pharmaceutical care services into their pharmacy practices were identified for inclusion by key informants. Sites considered for inclusion were within 300 miles of the University of Minnesota College of Pharmacy. The four innovative community pharmacy practices were located in Maquoketa, Iowa, and in Bemidji, Anoka, and Minneapolis, Minn. Published articles identified through a Medline search-using the terms pharmaceutical care, Medicaid, Medicare, pharmacist, pharmacy, and collaborative practice-provided information to prepare for pharmacist interviews. STUDY SELECTION By the authors. DATA EXTRACTION Previsit telephone interviews with each pharmacist, combined with literature selected by the authors, were used to identify common characteristics of successful practices. Structured, on-site empirical observation was then performed to devise a tool for pharmacists to use for the development of innovative community pharmacy practices. The tool was then validated by two additional practitioners. DATA SYNTHESIS Components of successful innovative community pharmacy practices include philosophy of practice, patient care process, management system, and clinical knowledge. A checklist tool is presented to be used in conjunction with the narrative description of the four components. CONCLUSION Advanced pharmacy services delivered within pharmaceutical care practices can be a successful business opportunity for community pharmacists. Community pharmacists motivated to develop an innovative practice and provide pharmaceutical care services can use the checklist tool during practice implementation.

Managing Drug-related Morbidity and Mortality in the Patient-centered Medical Home

Background:The appropriate use of medications can influence quality performance measures and costs. Drug-related morbidity and mortality represents a public health challenge due to the ineffective and unsafe consequences of medication use. This article addresses the impact of team-based care that incorporates comprehensive medication therapy management on per capita expenditures, quality performance measures, and resolution of drug therapy problems. Methods:A team-based medication therapy management system developed over 13 years in an integrated health system in 4 Minnesota innovation clinic sites was assessed in terms of: (1) differences in total median health expenditures compared with noninnovation clinics, (2) improvements on 5 performance benchmarks for patients with diabetes in comparison with statewide results, and (3) resolution of drug therapy problems. Results:Spending growth was 11% less in innovation clinics than that in 38 noninnovation clinics. Median per member per month health care costs measured at 5 intervals over a 15-month period were significantly lower in innovation than in noninnovation sites (P=0.05). Forty percent of patients with diabetes in the innovation clinics achieved all 5 performance benchmark treatment goals in 2009, with a range from 34% to 45%, compared with the statewide result of 17.5% of patients achieving all 5 benchmarks. In addition, over 4000 drug therapy problems were reported to be resolved. Conclusions:Team-based care helped to achieve quality performance and control spending growth through medication therapy management in a patient-centered medical home innovation.

Pharmaceutical Care, MTM, & Payment: The Past, Present, & Future

Central to any discussion of payment reform is the need for a rational scientific medication use system to ensure that drug-related morbidity and mortality are minimized. The care provision process is based on a comprehensive assessment of all of a patients drug-related needs and it behooves pharmacists to conduct a comprehensive assessment as do all other health professions. This comprehensive assessment is the foundation of medication therapy management (MTM) services provided within the practice of pharmaceutical care. Care can be delivered in the community by clinically oriented pharmacists, although building a practice is hard work much different from the business of dispensing medications. The number of pharmacists needed to provide comprehensive MTM services for every American is projected to range from 30,000 to 100,000 based on data/experiences from Minnesota, Ontario, and elsewhere. These individuals may benefit from some type of provider recognition so that society can differentiate between pharmacists who provide comprehensive MTM services and those in drug distribution roles. Approaching the legislature and policymakers with cost savings data, partnering with the business community, and focusing on dual eligible patients and those with unmet mental health needs are important strategies to make this practice transformation a reality.

Potential value of electronic prescribing in health economic and outcomes research

Improving access and quality while reducing expenditures in the United States health system is expected to be a priority for many years. The use of health information technology (HIT), including electronic prescribing (eRx), is an important initiative in efforts aimed at improving safety and outcomes, increasing quality, and decreasing costs. Data from eRx has been used in studies that document reductions in medication errors, adverse drug events, and pharmacy order-processing time. Evaluating programs and initiatives intended to improve health care can be facilitated through the use of HIT and eRx. eRx data can be used to conduct research to answer questions about the outcomes of health care products, services, and new clinical initiatives with the goal of providing guidance for clinicians and policy makers. Given the recent explosive growth of eRx in the United States, the purpose of this manuscript is to assess the value and suggest enhanced uses and applications of eRx to facilitate the role of the practitioner in contributing to health economics and outcomes research.

Choosing to use the most powerful model in the world.

It is an honor to present the 2013 William A. Zellmer Lecture. As I look across this gathering of influential pharmacy leaders, I am humbled to be selected for this honor. I want to begin by thanking each of you for the hard work you are doing to improve the care of the patients we serve and for