Role of the Clinical Pharmacist in Primary Care

Transcription

1 Role of the Clinical Pharmacist in Primary Care Amy Kramer, Pharm.D., Manager Clinical Pharmacy Services Kaiser Permanente Holly Miller, Pharm.D., BCACP, Primary Care Clinical Pharmacist Kaiser Permanente

2 Disclosure Presenters reported no financial interest relevant to this presentation

3 Objectives Discuss how to implement and justify clinical pharmacists in an outpatient setting. Describe how clinical pharmacists can provide value to both patients and providers. Review barriers and successes of pharmacist-run disease management programs

4 The Beginning of Clinical Pharmacy at Kaiser Permanente Ohio Kaiser Permanente is national company Successful practices are shared inter-regionally Data from other Kaiser regions showed for every one dollar invested in PharmD, a 2 dollar return Primarily cost savings from Drug Formulary Changes Influencing prescribing patterns Drug conversions Prevention of clinician appointments Prevention of ER visits or hospitalizations Started with 2 Clinical Pharmacists (PCCPs) in 2003

5 Kaiser Permanente Ambulatory Care Clinical Pharmacy Department Primary Care Clinical Pharmacists (PCCP) Decentralized in medical office buildings 2.5 Medication Management Pharmacists Centralized Manage anticoagulation, anemia monitoring, med lab monitoring, hepatitis C monitoring 1.0 Cardiac Risk Pharmacist 1.0 Pain Management/Behavioral Health Pharmacist 0.8 Oncology Clinical Pharmacist

6 Pharmacist Managed Asthma care Methods 1. Monthly HEDIS report on Asthmatics whom have not filled an ICS inhaler in 9 months 2. Daily report of internal and external ER admissions 3. Twice daily review of albuterol MDI and nebulizer refill requests to each PCP

7 Monthly No ICS Report Clinical pharmacist reviews chart for asthma criteria If ICS prescribed, clinical pharmacist outreaches to patient, educates, and schedules follow-up If ICS is NOT prescribed, clinical pharmacist develops care plan, gets PCP approval, outreaches to patient, educates, and schedules follow-up

8 ER Admission Reports PCP telephone appt within 1 week of ER admission Clinical pharmacist reviews chart for asthma criteria and schedules office visit with pharmacist. Office appt objectives 1. Complete updated ACT 2. Review and educate on proper inhaler technique & triggers 3. Develop and educate asthma action plan 4. Follow-up in 4 weeks for ACT

9 Albuterol Refill Request Review For each albuterol refill request, clinical pharmacist reviews chart for: Asthma vs COPD Adherence to ICS inhaler How often refilling/using albuterol Last ER visit or prednisone burst Clinical pharmacist makes recommendations based on above and may outreach to patient for ACT Follow-up in 4 weeks for repeat ACT

10 Value of Pharmacist Managed Asthma Care To PCP and Organization: -Decreased ER visits -Increased HEDIS scores -Formulary guidelines followed -Freed physician time To the Asthmatic Patient: -Increased access to health care provider -No cost to patient -Increased availability and shorter wait times -Individual education on inhaler technique and asthma triggers

11 Successes and Barriers Preliminary Asthma Results Successes HEDIS scores are increasing Increased awareness of asthma by PCPs Patient satisfaction with no copay appt Barriers Lack of prescriptive authority all charts need to be signed off and reviewed by PCP Patient lack of engagement Inaccurate Diagnosis from ER PCPs not waiting to sign the Proair refill request

12 Role of the Clinical Pharmacist in Primary Care Cari Cristiani, Pharm.D., BCPS Lisa Potts, Pharm.D., BCPS Clinical Pharmacy Specialists Cleveland Clinic

13 Disclosure Presenters reported no financial interest relevant to this presentation

14 Objectives Discuss how to implement and justify clinical pharmacists in an outpatient setting Describe how clinical pharmacists can provide value to both patients and providers Review barriers and successes of pharmacist-run disease management programs

15 Who We Are and What We Do Pharm.D. s with specialty residency training Internal Medicine at main campus Disease state management Diabetes, Hypertension, Hyperlipidemia Drug titration via Collaborative Practice Agreement Education (medication, disease state, lifestyle) Medication therapy recommendations Face-to-face visits

16 History of Clinic Implementation Reasons for clinic development Pharmacy need for experiential rotation site Close proximity of anticoagulation clinic Competency and desire of clinical pharmacists Means of clinic establishment Chart reviews Patient interviews and counseling pre/post visit Launch dedicated schedule and referral process

17 How Clinical Pharmacists Benefit Patients and Physicians Access: More frequent and rapid follow up Open MD slots for more complex patients Value: Identification and resolution of barriers to therapy Care Coordination Add on service to MD visit

18 Outcomes: Hypertension Initial HTN pilot 30 patients Care Coordination and Pharmacy Intervention BP -20/11 mmhg Barriers: Adherence Lifestyle Interventions: Medication changes Adherence Lifestyle Second project Improve referral process 3 month period Patients flagged Consults ordered Patients scheduled Pharmacy visits

19 Outcomes: Diabetes Insulin initiation Oral medication management Glucometer/device education N=50 A1c Baseline (mean) 10.1% A1c 6 months (mean) 7.82% Change in HbA1c Baseline to 6 months -2.3% (95% CI -1.27%, -3.66%) p<0.001

20 Successes and Barriers of Face-to-Face Pharmacy Clinic Successes Increase visit frequency Inspection of medications Physical assessment Patient education Medication administration Device use Disease state Patient-provider relationship PharmD MD relationship Barriers Clinical inertia for referrals Scheduling Reimbursement Transportation Parking fees Absence of medications or patient data at visit Collaborative practice restrictions

21 Thank You Questions?