Put pharmacists on primary care team, says Perdue CMO

January 15, 2010

Medication counseling and disease management are two important areas calling for pharmacist involvement, according to Roger Merrill, MD, chief medical officer for Perdue Inc., speaking to students at the University of Maryland School of Pharmacy during the annual Francis Balassone Memorial Lecture.

Key Points

"Physicians are not good at medication management. Pharmacists are," said Roger Merrill, MD, chief medical officer of Perdue Inc. "Pharmacists are good at drug interaction. Pharmacists are a trusted source of healthcare advice. And pharmacists provide value."

Pharmacists are particularly good at medication counseling, Dr. Merrill told students at the University of Maryland School of Pharmacy during the annual Francis Balassone Memorial Lecture. "And when progressing into disease management, you are not stepping on anyone's toes."

Dr. Merrill's prediction of a greater role for pharmacists in hands-on care is no surprise to UM pharmacy school dean Natalie Eddington.

"He has been a very vocal proponent for pharmacists and other healthcare practitioners," she said. "Pharmacists have shown for years that they can effectively improve health outcomes."

Dr. Merrill is a strong supporter of the patient-centered medical home, Eddington continued. The much-discussed care model combines a variety of health professionals in a care team that focuses on wellness and "well care" rather than on episodes of sick care. A personal physician coordinates care and health goals for each patient, but pharmacists and other specialists provide most of the hands-on care.

"The Asheville Project is one of the best examples out there," Dr. Merrill told Drug Topics. "Pharmacists are integral to Asheville's success in diabetes care and beyond. Pharmacists brought great value to patients and to payers. I see the potential for pharmacists to be actively involved in the primary care team."

Many associations that represent primary care physicians have been supporting the medical home model through the Patient-Centered Primary Care Collaborative and through the Medicare-Medicaid Advanced Primary Care Demonstration Initiative, Dr. Merrill said. And several major employers around the country have moved to some version of the patient-centered medical home, including Pitney-Bowes, Marriott, and Perdue Foods. The medical home model has improved patient outcomes and reduced overall costs for Perdue, he said.

With the vast majority of Perdue's 22,000 employees enrolled in the company's Health Improvement Program (HIP), company healthcare costs have nearly flatlined as national costs per company and per employee have continued to rise. At the same time, health outcomes for Perdue employees are significantly better than national averages.

Nationwide, just 34 percent of patients with hypertension are treated to standard, Dr. Merrill said. At Perdue, that percentage is in the 80s. National surveys show that approximately 37 percent of patients with diabetes achieve hemoglobin A1C goals, compared to 68 percent of Perdue employees.

"Pharmacists could be hugely helpful in our patient-care continuum," he said. "Pharmacists know more than I do about drugs and drug treatment. Pharmacists have patients' drug histories and are in the ideal place to review drug regimens and compliance. Pharmacists could be very useful in counseling patients. After all, if you have diabetes, the end point is not whether you are taking your drugs as prescribed. Rather, the end point is saving your foot from amputation. The pharmacist is the ideal person to be conveying that message every time they see the patient."