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Nothing rings truer than the voice of experience. Four pharmacists share what works for them.
Attendees at the recent annual meeting of the American Pharmacists Association in San Diego didn’t have to look far to find pearls of wisdom about pharmacy best practices. An entire session offered nuggets of advice about expanding medication therapy management (MTM) as the pharmacy industry evolves in the 21st century.
A federally funded pilot program in Arkansas for approximately 70 clinics statewide offers insight into opportunities and obstacles in the patient-centered medical home model, said Jeremy Thomas, PharmD, CDE, assistant professor at University of Arkansas for Medical Sciences.
With the goal of providing care management to at least 80% of its highest-risk patients, the Comprehensive Primary Care Initiative has integrated pharmacists into its program. Pharmacists are involved in patient care either directly or through chart reviews and recommendations, he said.
A major challenge is that clinics don’t understand the potential value of pharmacists in terms of MTM services. “They’re scared to death of reform in terms of payment, and they had no idea what pharmacists could offer patients in their clinic,” he said.
The solution was to identify target populations and define patient-care services that correspond with performance measures and clinical quality indicators, Thomas said.
Pharmacists practicing in a clinic setting as part of the healthcare team can make a difference in the patient-centered medical home model, according to Jaini Patel, BCACP, assistant professor of pharmacy practice at Midwestern University Chicago College of Pharmacy. She works at a clinic and often meets for 45 to 60 minutes with individual patients as part of an MTM program.
“I’ve spent as long as 90 minutes with a patient, since there was so much to discover and tackle,” Patel said. These meetings “are so crucial to develop relationships with the patients and caregivers. The patient walks out knowing what the plan is.”
A team that includes a physician and a pharmacist sees selected patients, she said. “The biggest advantage is everyone starts on the same page in terms of patients’ barriers, how they’re taking their medications, and what our goals and plan should be going forward. It’s efficient and saves everyone time because it prevents dual questioning.”
Physicians, team leaders, and patients often express appreciation. “I have never understood my medications until now!” one patient told her. “I’ve told all my friends to come meet my pharmacist.”
Marissa SalvoMarissa Salvo, PharmD, an assistant clinical professor at University of Connecticut School of Pharmacy, said communication is crucial to her role as a pharmacist providing e-consults in a multisite federally qualified health center.
Salvo provides consultations to providers and follows up with the patient and pharmacy as needed. She’s tackled a wide variety of issues such as finding alternative medications due to cost or formulary issues, setting renal and hepatic dosing, and even figuring out which vitamins are appropriate for a vegan.
“We have a new provider orientation, and there’s always a discussion about the pharmacy service,” she said. “For those who come to my site, I send a personalized e-mail, letting them know who I am and what I do there.”
In the big picture, she said, “pharmacists can expand their services using electronic health records to collaborate and provide patient care,” she said. “Use of the EHR allows the pharmacist to be at one location yet reach providers throughout an organization.”
At first, it may be difficult to get pharmacy staff to provide, document, and bill for MTM interventions because of a heavy dispensing workload, noted Melissa Enriquez, PharmD, of Quality Food Centers/Kroger Pharmacy.
The solution is coaching the staff and changing their attitudes within the pharmacy, she said. It helped to break long-term tasks into smaller, more feasible tasks. Instead of simply ordering staff to accomplish something, Enriquez said, it’s better to provide direction by saying something like “sign in by Monday and complete the three cases within the next two weeks.”
The coaching structure ultimately allowed impressive improvement in MTM numbers, she said.
Randy Dotinga is a medical writer based in San Diego, Calif.