Pharmacists in Federally Qualified Health Centers: Models of Care to Improve Chronic Disease

Abstract

IntroductionPharmacists are underused in the care of chronic disease. The primary objectives of this project were to 1) describe the factors that influence initiation of and sustainability for pharmacist-provided medication therapy management (MTM) in federally qualified health centers (FQHCs), with secondary objectives to report the number of patients receiving MTM by a pharmacist who achieve 2) hemoglobin A1c (HbA1c) control (≤9%) and 3) blood pressure control (<140/90 mm Hg).MethodsWe evaluated MTM provided by pharmacists in 10 FQHCs in Ohio through qualitative thematic analysis of semi-structured interviews with pharmacists and FQHC leadership and aggregate reporting of clinical markers.ResultsFacilitators of MTM included relationship building with clinicians, staff, and patients; regular verbal or electronic communication with care team members; and alignment with quality goals. Common MTM model elements included MTM provided distinct from dispensing medications, clinician referrals, and electronic health record access. Financial compensation strategies were inadequate and varied; they included 340B revenue, incident-to billing, grants, and shared positions with academic institutions. Of 1,692 enrolled patients, 60% (n = 693 of 1,153) achieved HbA1c ≤9%, and 79% (n = 758 of 959) achieved blood pressure <140/90 mm Hg.ConclusionThrough this statewide collaborative, access for patients in FQHCs to MTM by pharmacists increased. The factors we identified that facilitate MTM practice models can be used to enhance the models to achieve clinical goals. Collaboration among clinic staff and community partners can improve models of care and improve chronic disease outcomes.

The Mississippi Delta Health Collaborative Medication Therapy Management Model: Public Health and Pharmacy Working Together to Improve Population Health in the Mississippi Delta

“…The results of the MDHC MTM efforts strongly support the use of pharmacist-delivered MTM as a part of integrated care in rural Mississippi. MTM care delivery models have a considerable literature base to support its usefulness, although little research has targeted rural, Black populations in the Deep South (9, [16][17][18][19][20]. This program targeted a largely Black population in one of the most medically underserved areas in the United States.…”

“…mented as the quadruple aim of Interprofessional Collaborative Practice, supporting the value of close collaboration and heightened interprofessional communication on reducing the cost of care while promoting provider wellbeing and improving patient outcomes (14)(15)(16)(17)(18)(22)(23)(24)(25)(26). This MTM model supports the integration of pharmacists in collaborative, team-based care models in clinic settings such as this to achieve this goal.…”

Expanding comprehensive medication management considerations to include responses to the social determinants of health within the BDHelping Build Healthy Communities Program

“…CMM expands upon the medication optimization practices within MTM primarily by standardizing the process for optimizing medications and working with other members of the interdisciplinary team to ensure that each medication has an appropriate indication, is effective for the condition, can help in achieving clinical goals, is safe, and the patient can adhere to the regimen 6 . Because of CMM's documented positive impact in improving patient outcomes, FQHCs have been including CMM services in the care for their patients, especially for diseases which require more complicated medication regimens like diabetes mellitus 7‐11 . Accompanying this transition to patient‐centered CMM, is a growing push to apply the recommendations of the IOM and Healthy People 2030 to integrate SDOH into all aspects of the pharmacy workflow 5 .…”

The impact of clinical pharmacist led comprehensive medication management on diabetes care at Federally Qualified Health Centers within the BD Helping Build Healthy Communities program

“…These targets for glycemic control and blood pressure are of importance as they are recommended monitoring parameters federal agencies use when evaluating FQHCs. 7,8 The budgetary shortfalls FQHCs often face have forced many to operate in a minimalistic fashion, often leaving limited flexibility for incorporating novel services like CMM, which are not consistently reimbursed through Medicaid. 9,10 As an alternate solution, nonfederal funding sources, especially philanthropic funders, could play an important role in providing these centers with funds and resource to introduce novel programs designed to improve the care of vulnerable patient populations.…”