Patient-centered medical homes: Clinical pharmacy joins the team

UP FRONT IN DEPTH

The role of a clinical pharmacist at the patient-centered medical home (PCMH) where I practice in Columbus, Ohio, is to assist in the design of drug therapy regimens as they apply to patients with chronic disease.

Disease states

Disease states in this category include:

• Diabetes

• Hypertension

• Hyperlipidemia

• Weight loss

• Chronic kidney disease, stages 3 and 4 (CKD-3&4), as it relates to vitamin D deficiency and secondary hyperparathyroidism (SHPT)

• Non-narcotic chronic pain management

Collaborative visits

As an employee of the practice, I engage in what is termed a scheduled collaborative visit, a three-party activity that includes patient, physician, and pharmacist.

I am listed just as the physicians and physician assistants are in the practice’s electronic scheduling program, which shows the days of the week and the hourly schedule for seeing patients at the site.

I schedule follow-up visits for 15 minutes and new visits for 30 minutes. I see patients in the PCMH patient care room, just as if the visit were with a regular physician.

During my initial visit with the patient, I identify potential modification or continuation of current drug therapy, based upon current lab work, vital signs, and other patient-related information such as self-monitoring of blood glucose.

Then, in the outer area, I review my suggestions with the physician for concurrence, rejection of suggested changes, or continuation of the drug therapy for the patient with no changes.

The physician and I then proceed back into the patient care room. The physician explains to the patient why the current drug therapy needs modification. The physician asks the patient if there are any questions, and assures the patient that any changes being made are for the betterment of the treatment process for the health problems from which the patient suffers.

I may then assist the physician with changes to the medication order or continuation of the current regimen (refills).

Each week, in “sitting rounds” with the pharmacy student assigned to me, I review and discuss strategy for patients we will see the following week.

Electronic evaluation

Through the CeutiCare computer software program, algorithms have been developed for the following disease states and comorbid conditions: Diabetes; hypertension; hyperlipidemia; CKD-3&4, with vitamin D 25OH deficiency and SHPT; and non-narcotic pain management.

The CeutiCare software system evaluates patient information stored in the patient’s specific and individualized health record. It then offers up a best evidence-based clinical suggestion for drug therapy change.

The physician, after being presented the information in a mini-grand-rounds fashion, may either accept the suggestion and implement it; reject the initial change and continue on into the algorithm until they find an acceptable modification in therapy; or choose to hold any therapy changes until new lab values have been processed.

For each suggestion, the software also lists clinical reference points that may be shared with the managing physician, if the physician wishes to evaluate the pharmacist’s suggestion further.

The CeutiCare program continues to apply modifications as new medications come to market and are evaluated in our practice with patients.

The CeutiCare program was developed over a five-year period. It was evaluated for ease of use and clinical effectiveness through an evaluation process conducted in 2012 by the Cleveland Clinic’s Department of Family Medicine.

The software is available for commercial use. It can be adapted to interface with commercial electronic medical record (EMR) systems (it has its own internal mini-EMR) through a standard HL-7 connection.

Allen Nicholis COO/VP of Clinical Operations, CeutiCare LLC. Contact him at allennichol@aol.com.