Courtenay Gilmore Wilson

Evaluation of a Team-Based, Transition-of-Care Management Service on 30-Day Readmission Rates

BACKGROUND Transitions of care from the hospital to the outpatient setting often fail to meet the Triple Aim of improving quality, improving the health of populations, and decreasing the cost of care. A major push to improve the quality of transitions and reduce hospital readmissions is under way. METHODS We implemented a team-based, transition-of-care model and assessed the impact on 30-day readmission rates. The 3 components of the intervention were contact with a nurse care manager, medication reconciliation, and follow-up with a physician. We compared 30-day readmission rates for the period before versus after implementation of this intervention. RESULTS The 30-day readmission rate decreased from 14.2% in the usual care group to 5.3% in the intervention group (P = .011). Almost 90% of patients in the intervention group received all 3 components of the intervention. LIMITATIONS Generalizability is limited to practices with embedded team members. Not all patients received all 3 components of the intervention. CONCLUSIONS Development of a team-based intervention was associated with a significant reduction in hospital readmissions. This method could be implemented in other primary care offices with team-based care.

Assessing pharmacist-led annual wellness visits: Interventions made and patient and physician satisfaction

OBJECTIVES To quantify the nature and frequency of interventions made by pharmacists during a Medicare annual wellness visit (AWV), to determine the association between the number of medications taken and the interventions made, and to assess patient and physician satisfaction with pharmacist-led AWVs. SETTING Large, teaching, multidisciplinary family medicine practice in North Carolina. PRACTICE DESCRIPTION Mountain Area Health Education Center (MAHEC) is a large academic practice that serves rural, western North Carolina. There is a heavy emphasis on team-based care. PRACTICE INNOVATION Pharmacist-led AWV. EVALUATION Between April 2012 and January 2013, the following were evaluated for 69 patients: the nature and frequency of interventions made, the association between the number of medications taken and the interventions made, and patient and physician satisfaction scores. RESULTS A total of 247 medication-related interventions and 342 nonmedication interventions were made during the pharmacist-led AWVs. The majority of medication interventions (69.6%) involved correcting medication list discrepancies. The number of medications taken was positively associated with the total number of medication interventions (r = 0.37, P <0.01). On a 5-point Likert scale, patients strongly agreed that the AWV is important for their overall health (mean 4.8, median 5) and that they would like to see the same provider next year (mean 4.8, median 5). Physicians strongly disagreed that they would prefer to do the visit themselves (mean 1.5, median 1) and strongly agreed that their patients benefited from a pharmacist-led AWV (mean 5, median 4.9). CONCLUSION Pharmacists addressed both medication and nonmedication interventions during AWVs. Patients taking a greater number of medications required more medication interventions than patients taking fewer medications. Patients and physicians reported satisfaction with the pharmacist-led AWV.

The Integral Role of the Clinical Pharmacist Practitioner in Primary Care

Clinical pharmacist practitioners serve as integral team members in primary care clinics. They extend the care provided for patients with chronic illnesses, improve health and wellness, and positively impact quality metrics in patient-centered medical homes and accountable care organizations.

Essential factors demonstrating readiness of primary care practices for clinical pharmacy services

Purpose. The characteristics of primary care practices that are necessary to establish and maintain ambulatory care clinical pharmacy services were identified. Methods. A focus group of 15 ambulatory care pharmacists in Western North Carolina developed a survey of 26 practice readiness statements pertaining to the development of clinical pharmacy services in primary care. National ambulatory care pharmacy experts were then surveyed using a modified Delphi model for consensus building to determine which items were essential. Four rounds of surveys were completed. After each round, statements were accepted as consensus, modified, or removed from the survey based on responses. Statements were deemed to have reached consensus when 80% of respondents were in agreement. Results. A total of 6 statements reached agreement after 4 rounds of survey: (1) full integration into the team, (2) access to the electronic health record (EHR), (3) a physician or administrative champion, (4) appropriate equipment provided by the clinic, (5) a private room to see patients, and (6) a practice that is open to team‐based care. Conclusion. An expert panel of ambulatory care pharmacists identified 6 factors that should be considered prior to establishing ambulatory care services in primary care practices. Of these, foundational elements included full integration into the care team, presence of a physician or administrative champion, and a practice that is ready for team‐based care. Operational elements included access to the practices EHR, equipment provided by the practice, and private space to see patients.

Development of pharmacy resident leadership skills through creation of a regional ambulatory care forum

BACKGROUND AND PURPOSE Action-based leadership activities help refine leadership skills. This paper describes an experiential, longitudinal leadership experience for post-graduate year two (PGY2) pharmacy residents in ambulatory care. EDUCATIONAL ACTIVITY AND SETTING As part of a leadership and advocacy rotation, two PGY2 ambulatory care pharmacy residents collaborated with a state association, North Carolina Association of Pharmacists, to co-chair a newly formed regional ambulatory care forum in the western part of the state. The residents developed charges for the group, directed and organized the leadership team meetings, moderated the member events of approximately 30 participants, and served as liaisons to the state association and its members. Two residency preceptors who supervised the academic and leadership experiences for the residency program provided oversight for the residents with the forum. Residents completed written and oral self-reflections, received formative feedback from the forums leadership team and leadership preceptor, participated in a 360-degree leadership evaluation, and received quarterly summative evaluations. FINDINGS Skills developed included leading a group, event planning, advocacy, networking, communication, professional writing, creating a shared vision, teamwork, and collaboration. SUMMARY Serving in leadership roles within professional organizations can provide PGY2 pharmacy residents with practical hands-on leadership opportunities to help prepare them for positional and non-positional leadership roles in the future.

Providing Office-Based Treatment of Opioid Use Disorder

Office-Based Opioid Treatment (OBOT) with buprenorphine has been available since 2000; however, many barriers to OBOT within primary care exist, and only 3.6% of family medicine physicians are waivered to prescribe buprenorphine.1 We have successfully integrated OBOT into our primary care practice,

Interprofessional care for patients with osteoporosis in a continuing care retirement community.

OBJECTIVES To assess the quality of care provided to patients with osteoporosis in a continuing care retirement community (CCRC) after implementation of an interprofessional osteoporosis clinic (OPC). Specifically, quality measures were evaluated, including dual-emission X-ray absorptiometry (DXA) screening, calcium and vitamin D supplementation, and prescription treatment of osteoporosis and low bone mass in an ambulatory independent living community. SETTING Large family medicine teaching practice that provides primary care for residents in one main practice, 5 rural satellite practices, and 2 CCRCs. An interprofessional OPC was developed at the main practice in 2005. Patients at all of the organizations sites could be referred to the main practice for osteoporosis management. A needs assessment conducted at one of the CCRCs in 2011 revealed that rates of screening and treatment were suboptimal for its residents despite availability of an off-site OPC. PRACTICE INNOVATION In 2012, a new interprofessional OPC including a physician, medical assistant, and pharmacist was replicated on-site at the CCRC so that residents had access to this service within their medical home. EVALUATION Quality measures were evaluated after implementation of the team-based OPC on-site at a CCRC and included: 1) DXA screening; 2) calcium and vitamin D supplementation; and 3) prescription treatment of osteoporosis and low bone mass. RESULTS Twenty-nine patients were seen in the new OPC from January 2012 to August 2013. Ninety-three percent had appropriate DXA testing after OPC implementation. Patients accepted pharmacist recommendations regarding calcium and vitamin D supplementation 90% and 86% of the time, respectively. All but 4 patients received appropriate treatment for osteoporosis or low bone mass. CONCLUSION Providing a team-based OPC on site in a CCRC improved quality measures for screening and treatment of osteoporosis and low bone mass.