Presenter Contact Information: Thomas McCloskey PharmD, MS

Transcription

1 Presenter Contact Information: Thomas McCloskey PharmD, MS

2 Primary Care Partners Western Colorado Physicians Group Location: Grand Junction, CO Empanelment: Providers: 7, 5 mid-level Milestone 2 Focus: Behavioral Health Integration, Med.Ther.Mgmt. expansion, and Collab.Drug Therapy Mgmt Family Physicians of Western Colorado Location: Grand Junction, CO Empanelment: Providers: 17, 6 mid-level MS 2 Focus: BHI, MTM expansion, and CDTM

3 Primary Care Partners in Grand Junction 2 CPCI Practices Medium size practice Provides benefits by process improvements over a large population Application to small practice is limited, but there are opportunities. Location of practice N. 12 th & 1120 Wellington # providers total of 22 physicians and 8 mid-levels # empaneled patients 33,508 total # care managers/care coordinators 6 total EMR and/or modules used Allscripts Touchworks v HF12

4 Integration of an Ambulatory Pharmacist (for Dummies) Focus on MTM, including prospective medication profile reviews (modified from APhA, ASHP) TOC medication concerns including: AEs associated with drug-therapy, guideline compliance, med adherence CDTM-development of program to assist in smoking cessation, proposed HTN and anticoagulation Key points in the process Establish willingness to get involved, including direct patient contact Provide as many aspects of pharmaceutical care as possible within resource constraints: PPMI vs. reality While metrics are beneficial, sometimes you need to stop counting and start branding

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6 PCP s Pharmacist/Care Team Relationship MTM Program Start-up Direct Hire Relationship 2 practice sites Current workflow Onsite and Offsite with local acute care settings Medication Management Therapy Smoking Cessation, Pain Task Force TOC, IndiGO, CC and clinician ID of patients during huddles

7 Additional Medication Management Activity Smoking cessation: CDTM, collaborative with MCHD, SMH Chronic Pain Task Force Practice Transformation Participation in Project ECHO PainNet Development of CSA, ORT, EHR standardization Review PDMP, provision of pain tx recs., CE INR Protocol Development Employer Based Generic Drug Program Process improvements (QHN, SMH-PCP med rec)

8 Pharmacy Review Processes Processes were developed by clinical division physicians and care team. Patients with 5 or medications (generally 10 or more) High Risk Patients as stratified by the risk tool Transition of Care Patients with care-sensitive diagnoses High risk medications Consideration of national standards: NTOCC, AGS-GEMS Trends observed: increased requests for medication profile reviews drug information, cost/coverage data face-to-face patient contact when approaching medically complex patients (chronic pain, polypharmacy, smoking cessation)

9 Risk Stratification and Management of High Risk Patients Ongoing review and access to updated spreadsheet. Data includes: Comments, rank (subjective data) Office Visits/1yr(0.1), DOCSVisits/1yr (0.2), ERReport/1yr (1) Med Count (0.1), PharmRev Count (0.1), InPatHosp Count (3), PatAge, BMI, PHQ9 IndiGO, Frailty Scale Total Risk vs. Care Acuity/Clinical demands

10 Patient Chart Access/Tasks

11 Formal Pharmacy Reviews

12 MTM Disease Focus CHF Chronic Heart Failure registry Use of EHR to extract patient data, including medications (ACEI/ARB, BB, lipid management, anti-htn/diuretics, utilization stats, labs/tests, compliance, etc.) Ongoing reviews to assure meds are optimized, appropriate (BB), and AHA/ACC guidelines are employed whenever possible Follow up on hospitalizations, ED, consultant visits

13 PCP s Pharmacist/Care Team Relationship Implementing CDTM for Smoking Cessation Identified online resources for implementing CDTM State requirement for CDTM Physician /Pharmacist agreement on protocols Execute written agreement Who was/is involved in implementation? Advice for others

14 Integration of an Ambulatory Pharmacist $$??- 1:6 to 1:15 ROI TOC/MTM reviews Compliance checks (patient interviews, CSMP) CDTMs (HTN, anticoag., DM) While metrics are beneficial, sometimes you need to stop counting cows and start branding (for Dummies)