Improving Population Management through Pharmacist-Primary Care Integration: A Pilot Study

Abstract

Pharmacists have unique skills that may benefit primary care practices. The objective of this demonstration project was to determine the impact of integrating pharmacists into patient-centered medical homes, with a focus on population management. Pharmacists were partnered into 5 primary care practices in Vermont 1 day per week to provide direct patient care, population-based medication management, and prescriber education. The main measures included a description of drug therapy problems identified and cost avoidance models. The pharmacists identified 708 drug therapy problems through direct patient care (336/708; 47.5%), population-based strategies (276/708; 38.9%), and education (96/708; 13.6%). Common population-based strategies included adjusting doses and discontinuing unnecessary medications. Pharmacists' recommendations to correct drug therapy problems were accepted by prescribers 86% of the time, when data about acceptance were known. Of the 49 recommendations not accepted, 47/49 (96%) were population-based and 2/49 (4%) were related to direct patient care. The cost avoidance model suggests $2.11 in cost was avoided for every $1.00 spent on a pharmacist ($373,092/$176,690). There was clear value in integrating pharmacists into primary care teams. Their inclusion prevented adverse drug events, avoided costs, and improved patient outcomes. Primary care providers should consider pharmacists well suited to offer direct patient care, population-based management, and prescriber education to their practices. To be successful, pharmacists must have full permission to document findings in the primary care practices' electronic health records. Given that many pharmacist services do not involve billable activities, sustainability requires identifying alternative funding mechanisms that do not rely on a traditional fee-for-service approach.

Impact of pharmacists' interventions on the pharmacotherapy of patients with complex needs monitored in multidisciplinary primary care teams

“…‘Drug use without indication’ or ‘unnecessary therapy’ is common in studies conducted in hospitals . ‘Non‐adherence’ and ‘adverse drug reaction’ are more common to studies conducted in primary care and are more often detected by patient interviews . ‘Drug indicated but not prescribed’ is also frequent in some studies .…”

From programme theory to logic models for multispecialty community providers: a realist evidence synthesis

“…56 In the HealthOne Mount Druitt project (Australia), consultations also included 'more informal exchanges of information.' 80 Different patients might also have different but often overlapping provider networks, and these overlaps offered the greatest scope for strengthening care co-ordination. 67 Most papers described what care co-ordination activities MCP-like interorganisational networks undertook rather than how these co-ordination arrangements were created or (in the realist sense) their contexts.…”

“…91 In the Australian HealthOne Mount Druitt project, boundary-spanner care co-ordinators made patients feel more supported and less anxious and thus reduced hospital visits. 90 A reanalysis of administrative data in PCMHs and ACOs that involved pharmacists 80 found that pharmacists identified 708 drug therapy problems through direct patient care (336/708; 47.5%), population-based strategies (276/708; 38.9%) and education (96/708; 13.6%). Pharmacists combining academic detailing with direct patient care and population-based medication management probably helped to optimise patient outcomes.…”

“…Pharmacists combining academic detailing with direct patient care and population-based medication management probably helped to optimise patient outcomes. 80 Woodman et al 76 found that UK nurses making home visits in a Hospital at Home team improved child safeguarding and heightened awareness and paediatric referral to all community nursing services. In two cases, informants reported that commissioners and providers had warned of potential harm to children.…”

“…73 We found examples of HIT supporting relationships between physicians and pharmacists, for instance of pharmacists having shared access to the EHR to approve drug requests or, in one case, select patients for further physician screening. 80,100 Many studies noted the importance of creating a shared understanding between staff about routines, roles and processes. Some studies reported confusion as to the proper use of the EHR:…”