Mary Ann Kliethermes

Model for medication therapy management in a university clinic.

PURPOSE Experience with a referral-based medication therapy management (MTM) clinic in a university medical center is described. SUMMARY The MTM clinics mission is to assist patients who take multiple medications due to multiple chronic conditions with the management of their drug therapy to improve or maintain their health and prevent or minimize drug-related problems. The clinical services provided at the clinic have evolved into a comprehensive program providing five distinct service areas: access, adherence, coordination of care, medication therapy review, and education. During initial visits, patient information is collected, patients are interviewed, medications are reconciled, and the pharmacist identifies and attempts to solve any immediate drug-related problems and concerns. Routine visits are scheduled monthly to coincide with a patients medication refills. On a typical day, a minimum of two MTM pharmacists and one pharmacy technician staff the clinic. On two days of the week, three MTM pharmacists are available in the clinic. The clinic averages 9-13 scheduled patient visits per day. The MTM clinic functions as a subset of the outpatient pharmacy and is merged financially in the general operational budget of the ambulatory care pharmacy. This model of MTM patient care is intensive and comprehensive and is significantly different from the majority of MTM models currently provided by Medicare Part D plans. CONCLUSION A referral-based MTM clinic managed by pharmacists at a university medical center outpatient pharmacy provides care to patients with the goal of improving medication access, medication adherence, continuity of care, medication therapy management, and patient education.

Pharmacist engagement in medical home practices: Report of the APhA–APPM Medical Home Workgroup

OBJECTIVES To identify factors that have led to successful involvement of pharmacists in patient-centered medical home (PCMH) practices, identify challenges and suggested solutions for pharmacists involved in medical home practices, and disseminate findings. DATA SOURCES In July 2011, the American Pharmacists Association Academy of Pharmacy Practice & Management convened a workgroup of pharmacists currently practicing or conducting research in National Committee for Quality Assurance-accredited PCMH practices. DATA SYNTHESIS A set of guiding questions to explore the early engagement and important process steps of pharmacist engagement with PCMH practices was used to conduct a series of conference calls during an 8-month period. CONCLUSION Based on knowledge gained from early adopters of PCMH, the workgroup identified 10 key findings that it believes are essential to pharmacist integration into PCMH practices.

Integration of pharmacists into team-based ambulatory care practice models.

The provision of healthcare in the United States is undergoing dramatic changes due to the escalating healthcare costs in our country. New models of healthcare based on patient-centeredness, coordination of information, and multidisciplinary care teams are emerging in response to the triple aim of

Outcomes evaluation: striving for excellence in ambulatory care pharmacy practice.

PURPOSE Key issues in measuring and improving the quality of healthcare are discussed with an emphasis on applying quality-improvement principles in ambulatory care pharmacy practice. SUMMARY The various perspectives on healthcare quality (including those of patients, providers, and payers) are reviewed, and the basic principles of quality measurement and improvement are outlined. Many healthcare practitioners believe that the most effective way to improve healthcare is through balanced consideration of the structure, process, and outcomes of healthcare services. Overall progress in improving the quality of healthcare has been slow, in part because of lack of patient engagement, use of improvement methods that have not been fully tested, and inadequate attention to the systems of providing care. Ongoing efforts of national quality-improvement organizations are reviewed, including those of the government, accreditation bodies, payers, and professional associations. Of special interest in pharmacy is the work of the Pharmacy Quality Alliance, the Patient Safety and Clinical Pharmacy Services Collaborative, and the Center for Pharmacy Practice Accreditation. Ambulatory care pharmacists have important opportunities to improve healthcare quality, including by reducing adverse drug events, improving medication reconciliation and transitions of care, fostering medication adherence, improving patient medication self-management, providing immunization services, and reducing disparities in access to medications. CONCLUSION To be fully effective, the national priority of improving the quality of healthcare must penetrate the work of individual healthcare practitioners, including ambulatory care pharmacists.

The Effect of Clinical Pharmacists on Readmission Rates of Heart Failure Patients in the Accountable Care Environment

BACKGROUND Recent changes in the health care delivery landscape have expanded opportunities for clinical pharmacists in the ambulatory care setting. This article describes the successful integration of a clinical pharmacist-led chronic disease management service in a patient-centered medical home (PCMH) and accountable care organization (ACO) environment. PROGRAM DESCRIPTION In 2008, the year before PCMH implementation, 36% of patients who were hospitalized at Advocate Trinity Hospital for a heart failure exacerbation were readmitted within 30 days of their hospital stay for heart failure exacerbation. This high rate of heart failure hospital readmissions, compared with national standards, drove the implementation of the PCMH at Advocate Medical Group - Southeast Center (AMG-SE), the adjoining outpatient medical clinic. A clinical pharmacist was added to the health care team to help achieve the collective goal of improving patient outcomes and decreasing hospitalizations. OBSERVATIONS From November 1, 2009, through August 30, 2010, the clinical pharmacist conducted visits and intervened in the care of 111 chronic heart failure patients. A pre/post analysis of those 111 patients during the 10 months before and after the integration of the clinical pharmacist showed that those patients were hospitalized 63 times in the 10 months before having regularly scheduled visits with the clinical pharmacist and 30 times in the 10 months after establishing care. This reduction from 63 to 30 visits translated to an approximate 50% decrease in heart failure hospitalizations in patients being followed by the clinical pharmacist within the first 10 months. Once the clinical pharmacist became better integrated into the workflow through development of rapport with the medical team, the outcomes improved further. In an 18-month analysis from May 1, 2010, through November 30, 2011, only 2% of patients (3 of 153) designated as high-risk patients managed by the clinical pharmacist had a 30-day readmission for heart failure exacerbation. IMPLICATIONS Outcomes-based models have expanded opportunities for clinical pharmacist involvement and can provide unique reimbursement options. Demonstration of cost savings and an improvement in quality measures are paramount to establishing and justifying the clinical pharmacists role in a team-based model of care. DISCLOSURES No outside funding supported this research. The authors have no conflicts of interest to disclose.

Editorial: Inter-healthcare Professions Collaboration: Educational and Practical Aspects and New Developments

NF is a 62 year old female patient in good health. She is seeing her family physician for routine care, including managing her high blood pressure, annual check-ups, immunizations, and standard screenings. She also sees a podiatrist regarding a heel spur on her right foot, a GI specialist for GERD, an ophthalmologist for follow-up care after cataract surgery, a physical therapist for left knee pain, a dentist for a new crown, and her pharmacist manages all of her medications. She has a preferred provider organization (PPO) insurance plan so she can select her own care givers without going through her primary care physician. As a result, her “team” does not share any network, nor do they share an electronic medical record. Is her investment in health care seeing optimal results? Who is managing her care? The likely answer to this question is no one and everyone.

Pharmacists’ roles in patient-centered medical homes

Pharmacists can be critical players in PCMHs, helping patients make the best use of medications. Applying their knowledge and skills, pharmacists are drug-therapy experts on the health care team, promoting optimal medication therapy management as a key element of success in new models of care. Pharmacists are assisting integrated teams in ensuring optimal medication management and educating patients as active participants in their own health. As a result of the work of early adopters in providing pharmacists’ patient care services, the role of pharmacists within integrated