ISPP 2015

Career Opportunities in Pharmacy
CDC Grand Rounds: How Pharmacists Can Improve Our Nation’s Health


GOOD AFTERNOON.
I AM JOHN ISKANDER WELCOME TO THE OCTOBER, 2014 CDC
PUBLIC HEALTH GRAND ROUNDS. SPECIAL WELCOME TO THOSE JOINING
US FROM OUTSIDE OF CDC AND TO THOSE WATCHING NOT LIVE BUT
LATER FROM THEIR HOUSES, OFFICES, AND SCHOOLS.
CONTINUING EDUCATION CREDITS FOR PUBLIC HEALTH ROUNDS ARE
AVAILABLE FOR PHYSICIANS, NURSES, PHARMACISTS, OF COURSE,
HEALTH EDUCATORS AND OTHERS. ALL OF THIS INFORMATION IS
AVAILABLE ON THE GRAND ROUNDS WEBSITE, WHICH IS
CDC.GOV/CDCGRANDROUNDS. IT IS AVAILABLE ON MULTIPLE
SITES. WE HAVE A SITE ON YOUTUBE,
BEYOND THE DATA, POSTED SHORTLY AFTER THE SESSION.
A LITTLE BIRD TOLD ME TO TELL YOU THIS, SORRY, COULDN’T
RESIST. USE #CDCGRANDROUNDS FOR ALL OF
YOUR TWEETING NEEDS. PUBLIC HEALTH GRAND ROUNDS IS
HAPPY TO PARTICIPATE IN RECOGNIZING AMERICAN PHARMACIST
MONTH. PLEASE CONTACT THE AMERICAN
PHARMACIST ASSOCIATION WEBSITE FOR MORE INFORMATION.
IN ADDITION TO TODAY’S OUTSTANDING FEATURED SPEAKERS
WHO I WOULD LIKE TO THANK FOR THEIR IMPORTANT, ON-GOING WORK,
I WOULD ALSO LIKE TO ACKNOWLEDGE IMPORTANT CONTRIBUTIONS OF THE
INDIVIDUALS LISTED HERE, MANY OF WHOM ARE A MEMBER OF THE CDC
PHARMACIST WORK GROUP. WE PARTNERED WITH THE CDC PUBLIC
HEALTH LIBRARY AND INFORMATION CENTER TO FEATURE SCIENTIFIC
ARTICLES RELEVANT TO THIS SESSION.
THE FULL LISTING IS AVAILABLE AT CDC.GOV/SCIENCECLIPS.
HERE IS A PREVIEW OF UPCOMING GRAND ROUND SESSIONS.
JOIN US LIVE OR ON THE WEB AT YOUR CONVENIENCE.
FOR INTRODUCTORY REMARKS, I WOULD LIKE TO INTRODUCE THE
PRINCIPAL DEPUTY DIRECTOR. DOCTOR ILEANA ARIAS.
>>THANK YOU, AS MANY OF US KNOW, HEART DISEASE IS THE CAUSE
OF POOR HEALTH. ONE HALF OF AMERICANS HAVE ONE
CHRONIC CONDITION, ONE IN FOUR HAVE MULTIPLE CHRONIC
CONDITIONS. THE U.S. SPENDS APPROXIMATELY $2
TRILLION, ALMOST 85% OF ITS HEALTH CARE EXPENDITURES ON
CHRONIC DISEASE TREATMENT AND MANAGEMENT.
IN THE PAST DECADE, PRESCRIPTION DRUG USE IN THE U.S. INCREASED
STEADILY AND IS EXPECT TO CONTINUE TO GROW.
DATA FROM 2006, WHICH IS THE YEAR THAT WE HAVE THE MOST
RECENT DATA AVAILABLE INDICATE THAT ONE HALF OF AMERICANS TAKE
AT LEAST ONE PRESCRIPTION MEDICATION.
AND THIS IS MORE PRONOUNCED WHEN WE LOOK AT OLDER ADULTS.
NINE OUT OF TEN OLDER ADULTS USED AT LEAST ONE PRESCRIPTION
DRUG IN THE PAST MONTH. TWO-THIRDS OF ADULTS OVER THE
AGE OF 65 TAKE ANYWHERE FROM FIVE TO NINE MEDICATIONS.
AND ALMOST ONE QUARTER TAKE TEN OR MORE MEDICATIONS.
AND MOST OF THESE ARE USED TO TREAT CHRONIC DISEASE.
TODAY WE’RE FOCUSING ON THE CRITICAL BUT OFTEN OVERLOOKED
LINK BETWEEN PUBLIC HEALTH AND PHARMACY THAT CAN CONTRIBUTE
SIGNIFICANTLY TO HEALTH OUTCOMES IN SEVERAL PUBLIC HEALTH
PRIORITY AREAS FOR OUR COUNTRY. FOR EXAMPLE, DATA HAS
CONSISTENTLY SHOWN THAT PHARMACIST DELIVERED DRUG
THERAPY MONITORING, COUNSELING, AND EDUCATIONAL SERVICES
CONTRIBUTE TO IMPROVED HEALTH OUTCOMES FROM CHRONIC CONDITIONS
SUCH AS HYPERTENSION, DIABETES, AND HYPERLIPIDEMIA.
CDC HAS IDENTIFIED INCLUSION OF PHARMACISTS AS A CORE ELEMENT OF
ANTIBIOTIC STEWARDSHIP PROGRAMS ACROSS U.S. HOSPITALS TO COMBAT
ANTI-MICROBIAL RESISTANCE, AND CDC IS PIONEERING SUCCESSFUL
STRATEGIES TO EXPAND ACCESS TO HIV TESTING TO RETAIL
PHARMACIES. THE HEALTH CARE SYSTEM IS IN A
TIME OF TRANSFORMATION. THE AFFORDABLE CARE ACT WILL
INCREASE ACCESS TO HEALTH CARE FOR APPROXIMATELY 34 MILLION
AMERICANS. IT’S A CRITICAL TIME FOR US TO
FOCUS OUR STRATEGIES ON IMPROVING HEALTH CARE OUTCOMES
AND REDUCING UNNECESSARY COSTS. PHARMACISTS ARE EXTREMELY WELL
POISED TO ADDRESS THE BURDEN OF CHRONIC DISEASE AND TO IMPROVE
ACCESS TO QUALITY CARE. THERE ARE OVER 60,000 PHARMACIES
IN THE U.S. WITH 93% OF AMERICANS LIVING WITHIN FIVE
MILES OF A RETAIL PHARMACY. FOR YEARS, PHARMACISTS HAVE
CONSISTENTLY BEEN IDENTIFIED BY PATIENTS AS AMONG THE MOST
TRUSTED HEALTH CARE PROVIDERS. FOR CHRONIC DISEASES SUCH AS
HYPERTENSION AND DIABETES THAT THREATEN TO OVERWHELM OUR HEALTH
CARE SYSTEM, WE NOW HAVE ALMOST A DECADE’S WORTH OF DATA
DEMONSTRATING THAT WHEN PHARMACISTS ARE INTEGRATED INTO
THE PATIENT’S HEALTH CARE TEAM, THEY CAN REDUCE FRAGMENTATION OF
CARE, LOWER HEALTH CARE COSTS, AND IMPROVE HEALTH OUTCOMES.
AS KEY TRUSTED AND ACCESSIBLE HEALTH CARE PROFESSIONALS,
PHARMACISTS IN EXPANDED ROLES CAN HAVE POSITIVE IMPACT ON THE
HEALTH CARE SYSTEM AND ON PATIENT HEALTH IN NUMEROUS WAYS.
FOR EXAMPLE, THEY CAN IMPROVE ACCESS TO PREVENTIVE SERVICES
AND SAFELY DELIVER CARE IN AREAS LIKE IMMUNIZATIONS, TOBACCO
CESSATION, AND CARDIOVASCULAR REDUCTION.
LET’S NOT FORGET ABOUT 20% OF U.S. ADULTS, INCLUDING MY
HUSBAND AND OUR TWO CHILDREN, GET THEIR ANNUAL FLU SHOTS AT A
PHARMACY OR RETAIL STORE. PHARMACISTS CAN IMPROVE
MEDICATION ADHERENCE, CONTRIBUTE TO HEALTH CARE OUTCOMES, BLOOD
PRESSURE CONTROL AND FEWER EMERGENCY DEPARTMENT VISITS AND
HOSPITALIZATIONS. IMPORTANTLY THEY CAN ALSO PLAY A
VERY IMPORTANT ROLE PREVENTING HARM FROM MEDICATIONS BY
COUNSELING PATIENTS ON THE POTENTIAL FOR MISUSE AND ABUSE,
AND USING PRESCRIPTION DRUG MONITORING PROGRAMS TO ALERT
PRESCRIBER TO CASES OF EXCESSIVE USE OR ABUSE, AND POTENTIALLY
DANGEROUS DRUG COMBINATIONS. IN FACT, PHARMACISTS ARE AT THE
FRONT LINES OF THE PRESCRIPTION OVERDOSE EPIDEMIC AND MISUSED
ABUSE WHILE SAFEGUARDING LEGITIMATE ACCESS TO TREATMENT.
TODAY WE WILL HEAR ABOUT STRATEGIES THEY HAVE AT THEIR
DISPOSAL TO MAKE A DIFFERENCE. IT IS IMPERATIVE TO IDENTIFY AND
INTEGRATE THESE STRATEGIES AT THE NATIONAL, STATE AND LOCAL
LEVELS INTO PATIENT CARE. THIS MEANS LINKING OUR PUBLIC
HEALTH PROGRAMS TO PHARMACY PATIENT CARE SERVICES THAT HAVE
DEMONSTRATED POSITIVE OUTCOMES IN AREAS LIKE BLOOD PRESSURE
REDUCTIONS, DIABETES AND CHOLESTEROL CONTROL, MEDICATION
ADHERENCE, AND MEDICATION SAFETY.
ALSO IDENTIFYING NEW, INNOVATIVE WAYS THAT PHARMACY PATIENT CARE
SERVICES CAN SUPPORT THE PUBLIC’S HEALTH, AND ALLOWING
PHARMACISTS TO PRACTICE AT THE TOP OF THEIR LICENSE AS PART OF
THE HEALTH CARE TEAM. AS OUR POPULATION AGES, THE
GROWING COMPLEXITY AND BURDEN OF CHRONIC DISEASES DEMANDS WE
IDENTIFY NEW STRATEGIES TO PAY FOR QUALITY CARE, TO IMPROVE
OUTCOMES, AND TO CONTROL COSTS. WE ALL LOOK FORWARD TO SEEING
OUR NATION’S PHYSICIANS, NURSES, PHARMACISTS AND ALLIED HEALTH
PROFESSIONALS WORKING TOGETHER TO ACHIEVE THESE VERY IMPORTANT
GOALS. THANK YOU.
>>THANK YOU, DR. ARIAS. OUR FIRST SPEAKER, COMMANDER
MICHAEL LEE. THANK YOU, CDC AND PUBLIC
GRAND ROUNDS TEAM FOR PROVIDING US THE OPPORTUNITY TO COME HERE
AND SPEAK TODAY. TODAY YOU WILL HEAR ABOUT HOW
PHARMACISTS CAN SERVE A KEY ROLE IN IMPROVING PUBLIC HEALTH AND
HEALTH CARE AND SHARE WITH YOU SOME OF THE EVIDENCE TO SUPPORT
THIS. OUR U.S. HEALTH CARE SYSTEM IS
IN A TIME OF TRANSFORMATION. WE LOOK AT GOVERNMENT AND
PRIVATE GROUPS ACROSS THE COUNTRY, HAVE BEEN DEVELOPING
NEW MODELS OF CARE, BASED UPON CURRENT AS WELL AS PROJECTED
NEEDS. YOU LOOK AT THE MEDICAL HOME
MODEL IN WHICH WE ARE TRANSITIONING OUR CARE PLAN TO.
YOU LOOK AT THE TEAM BASED APPROACH PREVIOUSLY MENTIONED AS
WE WERE PRACTICING TO THE FULLEST OF OUR LICENSURE.
YOU LOOK AT GOVERNMENT PROGRAMS SUCH AS THE PARTNERSHIP FOR
PATIENTS, SUCH AS HEALTHY PEOPLE 2020, AND WHY, WHY IS THIS?
AT THE KEY POINT FOR EACH OF THESE IS ACCESS TO CARE AND
IMPROVEMENTS IN QUALITY OF CARE. THOSE ARE THE KEYS.
OUR U.S. HEALTH CARE SYSTEM IS AT A TIPPING POINT WHERE PEOPLE
HAVE EXPRESSED CONCERN ABOUT ACCESS TO CARE AS WELL AS
QUALITY CARE. ADDITIONALLY AS WAS PREVIOUSLY
MENTIONED, HEALTH CARE COSTS ARE AT ALARMING RATES.
THEY’RE INCREASING ON A DAILY BASIS.
FROM A MEDICATION STANDPOINT, MEDICATION ADHERENCE AS WELL AS
MEDICATION SAFETY ARE AT A TIPPING POINT.
YOU SEE GREATER ADHERENCE TO MEDICATIONS BY PATIENTS AS WELL
AS SAFER USE OF MEDICATIONS CAN IMPROVE THE QUALITY AND LOWER
COSTS AND PHARMACISTS, OUR PHARMACISTS ARE IN A KEY
POSITION TO EFFECT THESE CHANGES IN THE COMMUNITIES AND OUR
HEALTH CARE SETTING. DATA FROM THE ASSOCIATION OF THE
AMERICAN MEDICAL COLLEGES INDICATE THAT AS OUR POPULATION
AGES, THE SUPPLY OF PHYSICIANS IN THE U.S. IS BEING OUTSTRIPPED
BY THE DEMAND. IT IS ANTICIPATED BY THE YEAR
2020 WE WILL NEED BETWEEN 52 TO 91,000 NEW PHYSICIANS.
EXPAND THAT OUT TO 2025, 131,000 NEW PHYSICIANS.
ACCESS TO HEALTH CARE INSURANCE IS INCREASED RECENTLY FOLLOWING
THE PASSAGE OF THE AFFORDABLE CARE ACT, THAT’S INCREASED
ELIGIBILITY FOR HEALTH CARE INSURERS INTO OUR SYSTEM.
IN 2012, ACCORDING TO THE CDC, EXCUSE ME, THE CENTER FOR
MEDICARE AND MEDICAID SERVICES, THE U.S. SPENT MORE THAN 2.8
TRILLION IN U.S. HEALTH CARE EXPENDITURES.
APPROXIMATELY 1.7 TRILLION IN THAT U.S. HEALTH CARE DOLLAR HAS
BEEN ATTRIBUTED TO CHRONIC DISEASE.
THAT’S 60 CENTS OUT OF EVERY HEALTH CARE DOLLAR ATTRIBUTED TO
MANAGING CHRONIC CONDITIONS. OUR POPULATION IS AGING.
IN 2011, CDC DATA SHOWED OUR LIFE EXPECTANCY INCREASED TO
NEARLY 79 YEARS OF AGE. BY THE 2030s, ACCORDING TO
CENSUS BUREAU, ONE IN FIVE AMERICANS WILL BE OVER AGE 65.
CHRONIC CONDITIONS, CHRONIC DISEASE IS THE LEADING CAUSE OF
DEATH AND DISABILITY AMONG AMERICANS.
HALF OUR AMERICAN POPULATION HAVE MORE THAN ONE CHRONIC
CONDITION, AND ONE IN FOUR HAVE MULTIPLE CHRONIC CONDITIONS.
WHEN YOU LOOK AT SPENDING, 99% OF MEDICARE SPENDING IS RELATED
TO CHRONIC CONDITIONS. 81% OF OUR HOSPITALIZATIONS ARE
ACCOUNTED FOR BY PATIENTS WITH CHRONIC DISEASE.
WITH OUR POPULATION LIVING LONGER BUT EXPERIENCING GREATER
MORBIDITY, PRESCRIPTION MEDICATION USE HAS RISEN.
OUR AGING POPULATION IS USING MORE MEDICATIONS MORE
FREQUENTLY. NINE OUT OF TEN OLDER AMERICANS
TAKE ONE OR MORE MEDICATIONS. TWO-THIRDS OF AMERICANS GREATER
THAN THE AGE OF 65 TAKE BETWEEN FIVE AND NINE.
YOU SEE MEDICATIONS ARE ONE OF THE FOUNDATIONAL PIECES IN
MANAGING CHRONIC DISEASE. PATIENTS WITH CHRONIC CONDITIONS
ACCOUNT FOR 91% OF ALL PRESCRIPTIONS THAT ARE FILLED IN
OUR PHARMACIES ACROSS THE COUNTRY.
BECAUSE MEDICATIONS ARE AND DO COMPRISE SUCH A LARGE COMPONENT
OF OUR MEDICAL TREATMENT, PROBLEMS WITH THEIR USE HAMPER
OPTIMAL PATIENT CARE, ESPECIALLY FOR INDIVIDUALS WITH CHRONIC
DISEASE. AND THEY’RE COSTLY TO ALL OF US,
ABOVE AND BEYOND JUST THE COST OF THE MEDICATION ALONE.
PROBLEMS WITH MEDICATION USE HAS BEEN SHOWN TO BE COMMON, AND
MANY MEDICATIONS NOT TAKEN IN THE FIRST PLACE TO BEING TAKEN
AT THE WRONG TIME, WRONG DOSE, OR OTHER UNINTENDED WAYS.
20 TO 30% OF PRESCRIPTIONS ARE NEVER FILLED IN OUR PHARMACIES.
50% OF PRESCRIBED MEDICATIONS ARE NOT BEING TAKEN
APPROPRIATELY. AND THEY ARE MAJOR CONTRIBUTORS
TO EXCESS HEALTH CARE UTILIZATION.
SO GIVEN THE IMPORTANCE OF USING MEDICATIONS EFFECTIVELY AND AS A
WAY TO EFFECTIVELY HEALTH CARE QUALITY AS WELL AS LOWER COSTS,
IT SHOULD FOLLOW THAT OUR PHARMACISTS CAN BE MAJOR PLAYERS
IN HELPING TO IMPROVE ACCESS TO HEALTH IN COMMUNITIES
NATIONWIDE. YOU’LL SEE TODAY, BESIDES MAKING
INTUITIVE SENSE, THIS IS BACKED BY A SUBSTANTIAL AMOUNT OF
EVIDENCE FROM REAL WORLD SETTINGS.
PHARMACISTS ARE VERY ACCESSIBLE HEALTH CARE PROVIDERS.
THERE’S NEARLY 275 MILLION VISITS TO A PHARMACY EACH WEEK.
THAT IS REAL ACCESS. PHARMACISTS ARE WELL POISED TO
PROVIDE A NUMBER OF ADDITIONAL SERVICES BEYOND JUST THE USE OF
MEDICATIONS IN THE PRIMARY AS WELL AS SECONDARY PREVENTION.
ACCESSIBLE PREVENTIVE SERVICES AS WAS PREVIOUSLY MENTIONED,
IMMUNIZATIONS AND WHILE THE LIST IS NOT FULLY INCLUSIVE.
I WANT TO REPRESENT A FEW. RIGHT NOW, WE ARE THINKING ABOUT
THE INFLUENZA SEASON, AND GETTING FLU SHOTS AND
PHARMACISTS ARE WELL POISED AND GIVING FLU SHOTS EVERY DAY.
THEY PROVIDE CARDIOVASCULAR RISK REDUCTION CLINICS.
PHARMACISTS PROVIDE TOBACCO CESSATION.
VERY ACTIVE PRAYERS IN PROVIDING TOBACCO CESSATION ACTIVATION IN
CLINICS. DISEASE SCREENING AS WELL.
PHARMACISTS ARE HEAVILY INVOLVED IN DISEASE STATE MANAGEMENT,
THROUGH PATIENT EDUCATION ENCOUNTERS, THROUGH CARE TEAM
INVOLVEMENT, AS WELL AS CASE MANAGEMENT AND PROVIDING
THE FOLLOW-UP, DIRECT FOLLOW-UP CARE.
ADDITIONALLY PHARMACISTS ARE INVOLVED IN DISEASE MANAGEMENT
AND PROVIDE ADDITIONAL ACCESS TO PATIENTS WITH MULTIPLE DISEASES
AND AGAIN, I LIST JUST A FEW OF THOSE HERE.
HISTORICALLY, THESE WERE BORN OUT OF PHYSICIAN SHORTAGE,
HOWEVER REMOVING THE MODELS INTO A MODEL OF PLAYING EXPERT ROLE
ALONGSIDE OUR TEAMMATES WITH OUR PHYSICIAN, PAs, NURSE
PRACTITIONERS AND OTHERS. PHARMACISTS ARE INVOLVED WITH
DIABETES MANAGEMENT, CARDIOVASCULAR DISEASE,
PULMONARY DISEASE. AND WHILE TODAY’S PRIMARY FOCUS
IS AROUND CHRONIC DISEASE OUR PHARMACISTS DO PLAY AND ARE
PARTICIPATING IN THE CARE OF INFECTIOUS DISEASE, MOST NOTABLY
HIV AND HEPATITIS C. AND THEY ARE DOING GREAT IN
PROVIDING GREAT OUTCOMES IN THOSE AREAS.
WITH PHARMACIES SERVE AS HEALTHCARE LEADERS AND LEADERS
OF ADHERENCE PROGRAMS, WE SEE PATIENTS ARE MORE SATISFIED WITH
CARE, CAN UTILIZE THEIR MEDICATIONS BETTER, LOWER BLOOD
PRESSURE AS WELL AS HAVE FEWER EMERGENCY DEPARTMENT VISITS.
ONE EXAMPLE OF SOME DISEASE STATE MANAGEMENT COMES FROM THE
FACILITY IN WHICH I PRACTICE. WE HAVE A HEART FAILURE
MANAGEMENT PROGRAM IN ADDITION TO A NUMBER OF OTHER CLINICAL
SERVICES THERE IN OKLAHOMA. MUCH LIKE OTHER PROGRAMS, THIS
WAS DEVELOPED BASED UPON A NEED. IT WAS BASED
AS A TRANSITION OF CARE MODEL. THAT NEED WAS HEART FAILURE WAS
A COMMON DIAGNOSIS IN THE HEALTHCARE SETTING IN WHICH I
PRACTICE. PATIENTS WITH HEART FAILURE ARE
ALSO FREQUENTLY USERS OF THE EMERGENCY DEPARTMENT AND A
FREQUENT CAUSE FOR READMISSION. OUR PHARMACISTS BECOME INVOLVED
IN THE CARE OF THE PATIENT WHILE THE PATIENT IS HOSPITALIZED IN
THE HOSPITALIZATION. OUR PATIENTS — OUR PHARMACISTS
COME IN AND EDUCATE PATIENTS DIRECTLY AT THE BEDSIDE AND
PROVIDE CARE DURING THE HOSPITALIZATION.
ADDITIONALLY THAT CARE IS TRANSITIONED TO THE OUTPATIENT
SETTING AS WE FOLLOW THE PATIENT AND PROVIDE POST DISCHARGE CARE
AS WELL. WHAT WE’VE SEEN WITH THAT
PROGRAM IS A REDUCTION IN HOSPITALIZATION, A REDUCTION OF
READMISSION, A REDUCTION IN EMERGENCY DEPARTMENT USE AS WELL
AS INCREASED UTILIZATION OF THOSE MEDICATIONS MOST NOTABLY
KNOWN TO IMPROVE THE CARE OF PATIENTS WITH HEART FAILURE AND
APPROPRIATELY UTILIZE THOSE MEDICATIONS.
SO AS YOU WILL HEAR FROM MY COLLEAGUES TODAY, OPTIMAL USE OF
PHARMACISTS IN TODAY’S HEALTHCARE LANDSCAPE IS A KEY
INTERVENTION THAT CAN INCREASE THE QUALITY OF HEALTHCARE IN
BOTH MEASURABLE AND REPRODUCIBLE WAYS.
IT DOES MORE THAN EARN ITS KEEP BASED ON UPON ECONOMIC ANALYSES
WITH UP TO 12 DOLLARS OF SAVINGS WITH EVERY DOLLAR INVESTED.
IN PHARMACY PROGRAMS. I WANT TO RECOGNIZE ADMIRAL
SCOTT GUYVERSON AND CAPTAIN SHERRY YOEDER.
I WAS PRIVILEGED TO WORK ALONGSIDE THESE TWO AS ONE OF
THE CO-AUTHORS OF THE 2011 REPORT TO THE U.S. SURGEON
GENERAL. THIS DOCUMENT SUMMARIZED THE
EVIDENCE SUPPORTING THE CAUSE FOR PHARMACISTS IN EXPANDED
ROLES AND SHOWED THAT PHARMACISTS PROVIDING THESE
ROLES AS BOTH COST EFFECTIVE AND IMPROVES OUTCOMES.
IT IS AN EXCELLENT SOURCE FOR ADDITIONAL INFORMATION I WOULD
CERTAINLY REFER YOU TO. AGAIN, THANK YOU CDC FOR THIS
OPPORTUNITY. AND NOW I’D LIKE TO TAKE THIS
OPPORTUNITY TO INTRODUCE OUR NEXT SPEAKER, MS. ANN BURNS.
[ APPLAUSE ] THANK YOU COMMANDER LEE.
AND THANK YOU TO THE CDC FOR THIS OPPORTUNITY.
TODAY I WILL PROVIDE AN OVERVIEW OF PHARMACIST PATIENT CARE
SERVICES AND HIGHLIGHT HOW ADDRESSING PATIENTS’ UNMET
HEALTHCARE NEEDS. THE PHARMACY PROFESSION MOVED TO
AN ALL DOCTOR OF PHARMACY OR PHARM D DEGREE IN 2002 WHEN
TRAINING INCREASED FROM THE 5 YEAR PROGRAM TO MINIMUM OF SIX
YEARS. PHARMACISTS TRAIN EXTENSIVELY ON
THE CLINICAL APPLICATIONS OF MEDICATIONS IN TREATMENT AND
PREVENTION OF DISEASE. GRADUATES SERVE AS A SOURCE OF
COMPREHENSIVE MEDICATION INFORMATION FOR PATIENTS,
PHYSICIANS AND OTHER HEALTHCARE PRACTITIONERS.
PHARMACISTS ARE LICENSED BY STATE BOARDS OF PHARMACY.
AND THEY MUST PASS A NATIONAL EXAM AND MEET THE LAW AND
EX-PERFECT ENGINEERS REQUIREMENTS IN THEIR STATE OF
LICENSURE. VARIOUS POST GRAD TRAINING
EXISTS FOR PHARMACISTS TO BOOST THEIR SKILLS.
THEY USE A COLLABORATIVE CARE PROCESS TO DELIVER A VARIETY OF
PATIENT CARE SERVICES. THEIR MEDICATION RELATED
TRAINING POSITIONS THEM WELL AND HAS RESULTED IN INCREASED
EXPANSION AND UPTAKE OF MEDICATION MANAGEMENT AND
MEDICATION RECONCILIATION SERVICES AS WELL AS THOSE
FOCUSED ON PREVENTIVE CARE AND DISEASE MANAGEMENT.
MEDICATION MANAGEMENT IS AT THE HEART OF PHARMACIST TRAINING AND
ENCOMPASSES A SPECTRUM OF SERVICES THAT ARE FOCUSED ON
OPTIMIZING MEDICATION USE AND ENHANCING PATIENT SAFETY.
SERVICES ARE TAILORED TO THE INDIVIDUAL NEEDS OF PATIENTS AND
THEY SHOULD BE COORDINATED WITH THE PATIENT’S OTHER HEALTHCARE
SERVICES. PATIENTS MAY RECEIVE MEDICATION
RELATED SERVICES THAT FOCUS SOLELY ON MEDICATIONS, LIKE A
MEDICATION REVIEW FOR A COMPLEX PATIENT ON 15 MEDICATIONS,
SEEING FOUR DIFFERENT PHYSICIANS.
OR MEDICATION MANAGEMENT MAY BE A COMPONENT OF DISEASE
MANAGEMENT PROGRAMS SUCH AS FOR DIABETES OR CONGESTIVE HEART
FAILURE. MEDICATION RECONCILIATION THAT
INCLUDES AN ASSESSMENT OF MEDICATIONS IS CONSIDERED TO BE
A MEDICATION MANAGEMENT SERVICE. THERE IS CURRENTLY WIDE
MARKETPLACE VARIABILITY IN THE TERMINOLOGY AND ALSO THE SERVICE
DESIGN USED FOR MEDICATION MANAGEMENT SERVICES.
TO FACILITATE CONSISTENT DELIVERY, A PATIENT CENTERED MTM
SERVICE MODEL OUTLINES FIVE CORE ELEMENTS SHOWN HERE IN RED.
THE FOUNDATION OF THIS MODEL IS THE MEDICATION REVIEW AND IN A
COMPREHENSIVE MEDICATION REVIEW OR CMR, THE PHARMACIST ASSESSES
ALL OF THE PATIENT’S MEDICATIONS, INCLUDING
PRESCRIPTION, NONPRESCRIPTION, HERBAL, SUPPLEMENTS, FOR SAFETY,
EFFECTIVENESS, APPROPRIATENESS, AND ADHERENCE.
FROM THIS REVIEW, THE PHARMACIST CREATES A CARE PLAN AND THEN
WORKS COLLABORATIVELY TO ADDRESS, IDENTIFY PROBLEMS.
OUTPUTS OF THE CMR ARE A RECONCILED MEDICATION LIST AND
PATIENT SPECIFIC ACTION PLAN THAT THE PATIENT USES TO SELF
MANAGE THEIR MEDICATIONS. INTERVENTION, REFERRAL,
DOCUMENTATION, AND FOLLOW-UP ARE ALL INTEGRAL PARTS OF THIS
SERVICE MODEL. ADDITIONAL CMRs OR TARGETED
FOLLOW-UP REVIEWS ARE CONDUCTED TO ACHIEVE DESIRED OUTCOMES.
THE MEDICARE PART D MEDICATION THERAPY MANAGEMENT OR MTM
PROGRAM HAS BEEN IN PLACE SINCE 2006.
CMS CONTRACTS WITH PRESCRIPTION DRUG PLANS TO ADMINISTER THIS
BENEFIT TO TARGETED BENEFICIARIES.
EACH PLAN CREATES ITS OWN ELIGIBILITY CRITERIA FROM THREE
REQUIRED PARAMETERS. A MINIMUM NUMBER OF MEDICATIONS,
MINIMUM NUMBER OF CHRONIC CONDITIONS, AND A PREDETERMINED
ANNUAL DRUG SPEND. DIFFERENCES BETWEEN PLANS CAN
MEAN THAT A MEDICARE BENEFICIARY MAY BE ELIGIBLE FOR MTM IN ONE
PLAN BUT NOT ANOTHER. MTM BENEFICIARIES ARE ELIGIBLE
TO RECEIVE AN ANNUAL CMR, A PERSONAL MEDICATION RECORD, A
MEDICATION ACTION PLAN, AND QUARTERLY FOLLOW-UP MONITORING.
IN ADDITION TO MEDICARE PART D, COVERAGE OF PHARMACIST EDUCATION
MANAGEMENT SERVICES IS EMERGING IN STATE MEDICAID PROGRAMS SUCH
AS MINNESOTA, IOWA AND OHIO. PRIVATE SECTOR HEALTH PLANS,
OFTEN AS PART OF DIABETES MANAGEMENT PROGRAMS LIKE
DIABETES AND NEW HEALTH DELIVERY MODELS LIKE PATIENT CENTERED
MEDICAL HOMES AND ACCOUNTABLE CARE ORGANIZATIONS.
COLLABORATIVE CARE MODELS ARE EMERGING WHERE HEALTHCARE
PROVIDERS USE A TEAM BASED APPROACH TO COORDINATE CARE AND
IMPROVE HEALTH OUTCOMES. PHARMACISTS IN BOTH OUTPATIENT
AND INPATIENT SETTINGS CONTRIBUTE MEDICATION EXPERTISE
AND ALSO SKILLS IN DISEASE MANAGEMENT AND PREVENTION AS
MEMBERS OF THE HEALTHCARE TEAM. AS AUTHORIZED BY STATE LAW,
PHARMACISTS CAN ENTER INTO MORE FORMAL COLLABORATIVE PRACTICE
AGREEMENTS, OR CPAs, WITH PROVIDERS THAT PERMIT
PHARMACISTS TO PERFORM PATIENT CARE FUNCTIONS BEYOND THEIR
NORMAL SCOPE OF PRACTICE. THE TERMINOLOGY USED FOR THESE
AGREEMENTS CAN VARY FROM STATE TO STATE.
THERE IS ALSO STATE TO STATE VARIABILITY IN THE SERVICES
PHARMACISTS CAN PERFORM UNDER CPAs.
THE SERVICES OFTEN INCLUDE INITIATING, MODIFYING, OR
DISCONTINUING MEDICATIONS, AND ORDERING LABORATORY TESTS TO
MONITOR MEDICATIONS OR THE DISEASES ASSOCIATED WITH THEM.
TREATMENT ALGORITHMS MAY BE A COMPONENT OF CPAs.
THEY PROVIDE THE PHARMACIST WITH ADVANCE PERMISSION TO PERFORM
CERTAIN DELEGATED FUNCTIONS, SUCH AS ADJUSTING A MEDICATION
DOSE THEY WOULD NORMALLY NEED TO SEEK PERMISSION FROM THE
PROVIDER FOR, AND THEN MAKE THAT ADJUSTMENT LATER.
THE FEDERAL SECTOR HAS A STRONG HISTORY OF LEADERSHIP IN THE USE
OF CPAs. THIS MAP CREATED FROM 2014
NATIONAL ALLIANCE OF STATE PHARMACY ASSOCIATION’S DATA
SHOWS THE CURRENT AUTHORITY LAWS IN THE U.S.
CURRENT 48 STATES HAVE SOME FORM OF COLLABORATIVE AUTHORITY.
THE STATES IN GREEN HAVE BROAD AUTHORITY, WHERE THE STATES IN
YELLOW HAVE RESTRICTIONS IN PLACE.
SUCH AS BY PRACTICE SETTING OR BY TYPE OF DRUG.
OR BY CHRONIC CONDITION. OR BY HAVING THE AGREEMENT BE
FOR JUST A SINGLE PATIENT VERSUS A PHYSICIAN’S POPULATION OF
PATIENTS. PHARMACISTS IN THE TWO STATES IN
RED DO NOT CURRENTLY HAVE AUTHORITY.
THERE ARE MANY BENEFITS OF CPAs. PATIENTS HAVE IMPROVED ACCESS TO
CARE THROUGH EXPANDED PRIMARY CARE SERVICES THAT ARE DELEGATED
TO PHARMACISTS BY PROVIDERS. THE AGREEMENT IF WELL
CONSTRUCTED CAN REDUCE ADMINISTRATIVE BURDENS
ON PROVIDERS BY EMPOWERING PHARMACISTS TO PROVIDE CARE
FACILITATED BY THE AGREEMENT YET KEEPS THE PROVIDER INFORMED OF
THE PHARMACIST’S ACTIVITIES. CPAs ALSO FOSTER COLLABORATIVE
RELATIONSHIPS THAT ENHANCE COORDINATION OF CARE.
THIS SLIDE HIGHLIGHTS SOME EXAMPLES OF KEY PREVENTIVE
SERVICES PROVIDED BY PHARMACISTS.
IN ALL 50 STATES, PHARMACISTS ARE AUTHORIZED TO PROVIDE
IMMUNIZATIONS, ALTHOUGH THE TYPE OF VACCINE
ALLOWED AND THE PATIENT POPULATION CAN VARY BY STATE.
AS STATED EARLIER, NEARLY 1 IN 4 PATIENTS RECEIVED A VACCINATION
IN A COMMUNITY PHARMACY IN THE PAST YEAR.
AND IT IS ESTIMATED THAT 18 TO 24% OF PATIENTS RECEIVED THEIR
FLU SHOT FROM A PHARMACIST. HEALTH SCREENING SERVICES SUCH
AS FOR CHOLESTEROL, A1C, BONE DENSITY AND DEPRESSION ARE
OFFERED IN THE COMMUNITY TO HELP IDENTIFY PATIENTS WHO IS MAY
NEED TREATMENT. PHARMACISTS EDUCATE THE PATIENTS
AND CAN ALSO REFER THEM TO SEE A PROVIDER IF A DIAGNOSIS IS
NEEDED. COUNSELING AND EDUCATION
SERVICES IN AREAS SUCH AS SMOKING CESSATION AND LIFESTYLE
MODIFICATIONS ARE ALSO OFFERED BY PHARMACISTS.
THERE IS EXTENSIVE EVIDENCE THAT DEMONSTRATES THE VALUE OF
PHARMACIST SERVICES. A RECENT REVIEW PERFORMED BY
AVALERE HEALTH FOUND PHARMACIST MEDICATION MANAGEMENT, EDUCATION
AND BEHAVIORAL COUNSELING AND INCLUSION OF PHARMACISTS IN
COLLABORATIVE CARE MODELS HAVE BEEN SHOWN TO IMPROVE MEDICATION
ADHERENCE AND ALSO CLINICAL OUTCOMES FOR PATIENTS WITH
CHRONIC CONDITIONS, SUCH AS DIABETES, CARDIOVASCULAR DISEASE
AND HYPERTENSION. MEDICATION RECONCILIATION CAN
DETECT AND REDUCE MEDICATION DISCREPANCIES AND ALSO REDUCE
ADVERSE DRUG EVENTS. PHARMACISTS ARE EFFECTIVE IN
DELIVERING IMMUNIZATIONS AND MAY BE ABLE TO INCREASE VACCINATION
RATES PARTICULARLY FOR CERTAIN POPULATIONS AND VACCINES.
AND GIVEN THEIR COMMUNITY PRESENCE, PHARMACIST SCREENING
SERVICES CAN SERVE AS A PLATFORM FOR PUBLIC HEALTH INITIATIVES.
A RECENT SYSTEMIC REVIEW OF THE PART D MTM PROGRAM FOUND
ADHERENCE AND QUALITY PRESCRIBING WERE IMPROVED
THROUGH MEDICATION MANAGEMENT, ESPECIALLY
WITH COMPREHENSIVE MEDICATION REVIEWS.
AS AN ACCESSIBLE HEALTHY HEALTHCARE PROVIDER WITH
EXPERTISE IN THE APPROPRIATE USE OF MEDICATIONS, PHARMACISTS CAN
CONTRIBUTE TO BETTER HEALTH AND HELP ADDRESS UNMET NEEDS IN THE
HEALTHCARE SYSTEM. OUR NEXT SPEAKER WILL PROVIDE
FURTHER INSIGHT INTO THE INNOVATIVE PROGRAMS SHE’S
WORKING WITH. THANK YOU.
[ APPLAUSE ] THANK YOU.
GOOD AFTERNOON. IT IS A PLEASURE FOR ME TO BE
HERE WITH YOU TODAY PRESENTING AT GRAND ROUNDS.
TODAY I’M GOING DESCRIBE TO YOU THE MARYLAND P3 PROGRAM AND
HIGHLIGHT MAJOR COMPONENTS AND OUTCOMES.
WE WANTED THIS TO SERVE AS AN EXAMPLE OF THE IMPACT THAT
PHARMACISTS AND MEDICATION MANAGEMENT SERVICES CAN HAVE IN
IMPROVING CARE AND REDUCING OVERALL COST.
THIS PROGRAM HAS PARTNERED WITH THE DEPARTMENT OF HEALTH AND
MENTAL HYGIENE IN MARYLAND AND ALSO WITH CDC IN THE PROGRAMS
FOR CHRONIC DISEASE PREVENTION AND CONTROL.
THE P3 PROGRAM IS WHAT WE CALL AN EFFECTIVE SOLUTION TO
PATIENT CENTERED COMPREHENSIVE MEDICATION THERAPY MANAGEMENT
AND CHRONIC DISEASE MANAGEMENT. WE ALREADY HEARD THE MEDICATIONS
ARE ESSENTIAL IN THE MANAGEMENT OF CHRONIC DISEASES, MAKING
MEDICATION MANAGEMENT A LOGICAL SERVICE TO ADDRESS MEDICATION
ADHERENCE AND IMPROVE OUTCOMES. THE GOALS OF A PROGRAM ARE AS
FOLLOWS. IS TO OPTIMIZE MEDICATION USE
AND IMPROVE CLINICAL OUTCOME. BY DOING SO WE HAVE BEEN ABLE TO
SEE THAT NOT ONLY CAN WE IMPROVE MEDICATION.
BUT WE CAN DECREASE MEDICATION COST.
WE HAVE BEEN ABLE TO DEMONSTRATE THAT WE CAN REDUCE UNNECESSARY
EMERGENCY DEPARTMENT VISITS AND HOSPITALIZATION, REDUCE SICK
DAYS, AND REALLY IMPROVE ADHERENCE AND UNDERSTANDING OF
DRUG THERAPY. PATIENTS THAT ARE PART OF THIS
PROGRAM ARE BETTER ABLE TO MANAGE THE MEDICAL CONDITIONS.
AND IN MANY CASES EVEN STOP TAKING THE MEDICATIONS BECAUSE
THEY ARE ABLE TO CONTROL BETTER THEIR DISEASE.
WE HAVE ASSEMBLED A VARIETY OF PARTNERS IN THE PROGRAM THAT
INCLUDE ACADEMIC, PROFESSIONAL AND GOVERNMENTAL AGENCIES.
AS YOU CAN SEE HERE IN THE SLIDE WE HAVE BEEN ABLE TO ALIGN
INCENTIVES TO A VARIETY OF PARTNERS TO REALLY NEAT GOALS OF
— MEET THE GOALS OF OUR PROGRAM.
WE HAVE BUSINESS CORRELATIONS, PHARMACY ORGANIZATIONS AS WELL
AS ACADEMIC AND GOVERNMENT AGENCIES.
BY ALIGNING INCENTIVES WE’RE ABLE TO ENGAGE THESE PARTNERS
FOR MAXIMAL IMPACT AND POTENTIAL COLLABORATION AMONG THE
DIFFERENT ENTITIES. I WANTED TO DESCRIBE TO YOU THE
PROCESS OF CARE THAT GOES ON WHEN PATIENTS ARE PART OF OUR
PROGRAM. AND AS I ALLUDED, WE DO PROVIDE
WHAT WE CALL COMPREHENSIVE MEDICATION THERAPY MANAGEMENT.
HERE THE PHARMACISTS ARE ABLE TO EVALUATE AND ASSESS ALL THE
MEDICATION REGIMENS OF THE PUSHER, INCLUDING OVER THE
COUNTER AND HERBAL PRODUCTS. THEY’RE ABLE TO COUNSEL PATIENTS
TO ASSIST THEM WITH MEDICATION ADHERENCE, AND ALSO TO BE ABLE
TO COACH THEM IN SELF MANAGEMENT SKILLS.
WE DO THIS IN COLLABORATION WITH THE TEAM, AND THE PATIENT’S
PRIMARY CARE PROVIDER, AND OFTEN WE COMMUNICATE WITH THEM TO
IDENTIFY WHAT ARE THE AREAS THEY WANT TO EMPHASIZE IN
AN ENCOUNTER WITH A PHARMACIST. WE ARE ABLE TO PRODUCE AT EACH
ENCOUNTER ELECTRONIC DOCUMENTATION THAT IS SAYING TO
THE PATIENT’S PROVIDER TO BE PART OF THE MEDICAL CHART.
IF WE DETECT THERE ARE ANY ISSUES IN THE INTERMEDIATE
ATTENTION THOSE ARE ADDRESSED BY COMMUNICATING BY PHONE WITH THE
PROVIDER. AND WE ARE ABLE IN MANY
INSTANCES TO MAKE CHANGES IN MEDICATIONS RIGHTS THERE,
PREVENTING UNNECESSARY VISIT TO THE EMERGENCY ROOM AND DECREASE
THE OVERALL HEALTH CARE COST. THESE ENCOUNTERS WITH THE
PATIENTS ARE FACE TO FACE. IT COULD BE AT THE WORK SITE OR
THE LOCAL PHARMACY. AND ON AVERAGE WE MEET WITH THE
PATIENT BETWEEN FIVE AND SEVEN TIMES A YEAR.
THIS IS AT TIME THAT IS MUTUALLY AGREEABLE WITH THE PATIENT.
AND THE TYPICAL LENGTH OR INITIAL VISIT IS ABOUT 60
MINUTES AND FOLLOW-UPS ABOUT 30 MINUTES.
I ALLUDED WE DO HAVE A DOCUMENTATION SYSTEM.
AND THIS WAS DEVELOPED IN COORDINATION WITH A PARTNER.
THIS IS A TECHNOLOGY COMPANY THAT HAS A
LOT OF EXPERIENCE IN ELECTRICAL RECORDS AND ALSO THE CHANGES IN
VARIOUS STATES. BY DOING SO WE ARE ABLE TO
CREATE TOOLS THAT ARE PROVIDED TO PATIENTS AND TO CARE GIVERS
SUCH AS MEDICATION ACTION PLANS, PERSONAL MEDICATION RECORDS AND
APPOINTMENT CALENDARS. ONE OF THE THINGS THAT WE’RE
EXPLORING IS LINKING OUR SYSTEM TO MARYLAND’S HEALTH INFORMATION
CHAIN TO ALLOW PRIMARY CARE PROVIDERS TO BE ABLE TO HAVE
ACCESS TO THE INFORMATION INPUT FROM THE PHARMACISTS AS WELL AS
HAVING THE PHARMACISTS HAVE ACCESS TO A DATA IN A CHANGE OF
HOSPITALIZATION — VISITS AND LAB DATA.
OUR PROGRAM STARTED IN 2006. AND AS OF TODAY WE REALLY HAVE
FOCUS WITH SELF INSURED EMPLOYERS AS YOU SEE LISTED
HERE. AND WE ARE IN A VARIETY OF
STATES WHERE WE’RE PROVIDING THE SERVICES.
WE ARE UTILIZED A NETWORK OF PHARMACISTS.
THESE PHARMACISTS COULD BE PHARMACISTS THAT WORK IN
INDEPENDENT PHARMACIES, IN CHAIN PHARMACIES OR IN MANY CASES WE
ALSO HAVE CONSULTANT PHARMACISTS THAT ARE PART OF OUR PROGRAM.
THEY ARE TRAINED IN A PROCESS OF CARE.
THEY ARE TRAINED IN THE DOCUMENTATION SYSTEM.
AND ONE OF THE THINGS THAT WE FIND IS THAT WE REALLY PROVIDE
WHAT WE CALL AN UN BIAS EVIDENCE BASED CARE.
BY BEING A PROGRAM THAT IS LED BY ACADEMIC CENTER WE FIND THERE
IS A LOT OF SATISFACTION FROM THE PARTICIPANT AND FROM THE
EMPLOYERS BECAUSE THEY SEE THE PROGRAM IS NOT REALLY TIED
DIRECTLY TO THE EMPLOYER, SO IT IS A BUSINESS BUT REALLY IS LED
BY EVIDENCE BASED BY ACADEMIC CENTER SO WE DO HAVE A PRETTY
HIGH SATISFACTION WITH THE PROGRAM.
>>WE HAVE BEEN ABLE TO SHOW A SIGNIFICANT TRACK RECORD OF
IMPROVEMENT IN CLINICAL INDICATORS.
WE’VE BEEN ABLE TO SHOW REDUCE OF OVERALL COSTS ONCE THE
PROGRAM IS IMPLEMENTED AND HAVE BEEN ABLE TO SHOW AS I STATED
HIGH SATISFACTION NOT ONLY FROM EMPLOYER BUT EMPLOYEE AND THEIR
DEPENDENTS. AND IN THE NEXT SET OF SLIDES
I’LL SHARE WITH YOU CLINICAL DATA AND ALSO SHARE WITH YOU
SOME OF THE ECONOMIC DATA THAT WE’VE BEEN ABLE TO SEE IN THE
PROGRAM. WE ARE COMPARE PROGRAM WAS WE
LOOK AT THE IMPACT. THERE ARE ALREADY BENCHMARKS
THAT ILLUSTRATE WHAT THE CONTROL FOR CERTAIN INDICATORS SHOULD
BE. SO WHAT WE DO IS YOU SEE HERE
THE P3 PROGRAM IS IN BLACK. AND WE COMPARE OURSELVES TO
COMMERCIAL PLANS. SO WE’VE BEEN ABLE TO BENCHMARK
OUR PROGRAM AGAINST MARYLAND AS WELL AS NATIONAL IN COMMERCIAL.
AND IN A1C, BLOOD PRESSURE CONTROL AND LDL WE’VE BEEN ABLE
TO DEMONSTRATE THE PATIENTS IN OUR PROGRAM ACHIEVE A MUCH
HIGHER PERCENTAGE OF CONTROL IN THESE METRICS.
THESE HAD BEEN SUSTAINED YEAR AFTER YEAR.
AND I HAVE DATA FROM 2012. P3 IN THE BLACK.
JUST TO ILLUSTRATE TO YOU THAT THIS HAS BEEN A CONSISTENT AND
SUSTAINABLE EFFECT WE HAVE SEEN IN TERMS OF MEASURES.
WE ALSO MONITOR A LOT OF OTHER OUTCOMES OF THE PROGRAM.
SO ADDITIONAL CLINICAL OUTCOMES THAT WE HAVE OBSERVED IS A
REDUCTION IN MEDICATION RELATED PROBLEMS.
AGAIN, MEDICATION ADHERENCE, AND MEETING WITH T
PATIENT ON A FREQUENT BASIS. AND HAVE BEEN ABLE TO SEE FOR
MANY PATIENTS FOR EXAMPLE WE REDUCE EPISODES OF THE
HYPOGLYCEMIA. BEEN ABLE TO INCREASE ADHERENCE
AND PERSISTENCE. AND PROVIDER AND PATIENT
SATISFACTION. THE ECONOMIC ANALYSIS, WHAT WE
DO IS WE PROVIDE THESE TO OUR EMPLOYERS.
SO WE OBTAIN DATA FROM THIRD PARTY ADMINISTRATOR AND
FROM PRESCRIPTION BENEFIT MANAGERS,
AND WHAT WE DO IS USE OUR PATIENTS AS THEIR OWN CONTROL.
WE LOOK AT WHAT IS THE OVERALL COST OF THAT — FOR THAT
EMPLOYER OR THAT PARTICULAR PATIENT 12 MONTHS PRIOR TO
IMPLEMENTATION OF THE PROGRAM AND 12 MONTHS AFTER.
AND CONSISTENTLY WE’VE BEEN ABLE TO DEMONSTRATE THAT WE DO
DECREASE OVERALL HEALTHCARE COSTS EVEN WHEN THE EMPLOYER IS
PAYING FOR THE COSTS OF THE PROGRAM.
ONE OF THE THINGS THAT EMPLOYEES GET ARE SOME INCENTIVES TO
PARTICIPATE IN THE PROGRAM IS THAT WE WAIVE CO-PAYS FOR THE
MEDICATIONS FOR THE CONDITIONS THAT WE’RE TREATING AND THE
SUPPLIES. SO EVEN WHEN WE ACCOUNT FOR THE
INCREASED COST TO THE EMPLOYER OF THE WAIVE CO-PAY, EVEN WHEN
WE ACCOUNT FOR THE COST OF THE PROGRAM WE ARE ABLE TO
DEMONSTRATE THAT THERE IS AN OVERALL DECREASE IN OVERALL
HEALTHCARE COST FOR THAT PARTICULAR EMPLOYER.
THESE COSTS IS ESTIMATED TO BE $1,000 PER PATIENT PER YEAR
ACROSS THE EMPLOYER AND PATIENT POPULATION THAT WE HAVE.
BUT WE DO HAVE ONE PARTICULAR EMPLOYER THAT IS A SCHOOL
SYSTEM, WHERE AGAIN, THEY HAVE BEEN ABLE TO SEE EVEN HIGHER
DECREASES IN HEALTHCARE COSTS. FOR EXAMPLE, THEY OBSERVE $2,451
PER PATIENT. AND ONE OF THE INTERESTING
THINGS WE SAW IN THIS ANALYSIS OF THIS GROUP IS THE 33%
REDUCTION OF HOSPITALIZATION IN THE COHORT THAT WAS ENROLLED IN
THE PROGRAM. WE WERE ABLE TO SEE THAT WHEN
THEY CALCULATED FOR INCREASED AND IMPROVED PRODUCTIVITY THEY
ACTUALLY SAVED AN ADDITIONAL $1,047 PER EMPLOYEE IN INCREASED
PRODUCTIVITY. WE’RE TRACKING SICK DAYS IN THIS
POPULATION. AND THIS DATA HAS BEEN A LITTLE
BIT MORE VIABLE. WE OBSERVED THAT IN CERTAIN
YEARS THE P3 GROUP HAD A DECREASE IN SICK DAYS BUT IN
OTHER YEARS WE OBSERVED AN INCREASE.
SO WE ARE IN THE PROCESS OF DOING MORE ANALYSIS OF THE DATA
TO SEE WHAT ARE THE FACTORS THAT ARE INFLUENCING THE VIABILITY IN
THE DATA. BECAUSE OF WHAT WE’VE SEEN WITH
THIS SELF INSURED EMPLOYERS AND SEEING WHAT IS GOING ON IN THE
HEALTHCARE SYSTEM, WE ARE ACTUALLY EVOLVING OUR MODEL TO
REALLY ENHANCE IT. TO BE ABLE TO FULFILL A NEED IN
TRANSITION OF CARE. SO WE ARE WORKING WITH HEALTH
SYSTEMS WITHIN OUR OWN UNIVERSITY TO BE ABLE TO EXPAND
THE SCOPE OF OUR SERVICES TO PROVIDE MORE CONTINUATE HEALTH CARE AND ALSO ACHIEVE A REDUCTION IN READMISSIONS.
INCORPORATING NOT ONLY FACE TO FACE INTERACTIONS BUT ALSO
INCORPORATING PHONE FOLLOW-UPS AND ALSO THE USE OF TELEHEALTH.
IN SUMMARY, HAVE PRESENTED TO AN ACADEMIC LED PARTNERSHIP BEEN
ABLE TO DEMONSTRATE OUTCOME AND REDUCTION OF COSTS.
WE PROVIDE MEDICATION THERAPY MANAGEMENT AS PART OF TEAM CARE,
WORKING WITH THE PATIENT’S PHYSICIAN.
AND WE’VE BEEN ABLE TO YIELD BENEFITS NOT ONLY TO THE
PATIENTS IN TERMS OF IMPROVED HEALTH BUT TO OTHER HEALTHCARE
PROVIDERS BY INCREASING COMMUNICATION, THE EMPLOYER AND
INSURERS. AND AGAIN WE’RE EXPANDING THIS
TO MAKE THIS IN A MORE BROADER PROGRAM TO DECREASE READMISSIONS
AND IMPROVE CONTINUUM CARE. OUR NEXT SPEAKER IS
DR. LORI HALL. [ APPLAUSE ]
>>THANK YOU. I’M LORI HALL AND ONE OF ABOUT
30 PHARMACISTS AT THE CDC. IT IS MY PLEASURE TO TALK WITH
YOU ABOUT WHY INCLUDING PHARMACISTS IN TEAM BASED CARE
IS IMPORTANT. SOME TOOLS CDC HAS DEVELOPED TO
HELP INCORPORATE PHARMACISTS AND SOME EXAMPLES OF WHAT IS WORKING
IN PUBLIC HEALTH. THE COMMUNITY PREVENTIVE
SERVICES TASK FORCE UPDATED A EFFECTIVENESS OF TEAM BASED CARE
FOR BLOOD PRESSURE CONTROL BY REVIEWING 52 STUDIES WITH A TEAM
BASED APPROACH WITH NURSES AND PHARMACISTS WORKING IN
COLLABORATION WITH PRIMARY CARE PROVIDERS, PATIENTS AND OTHER
PROFESSIONALS. BASED ON STRONG EVIDENCE THE
TASK FORCE RECOMMENDS TEAM BASED CARE TO IMPROVE BLOOD PRESSURE
CONTROL. IN ADDITION TO IMPROVEMENTS IN
BLOOD PRESSURE OUTCOMES, TEAM BASED CARE WAS EFFECTIVE IN
IMPROVING OTHER CARDIOVASCULAR RISK FACTORS INCLUDING DIABETES
AND CHOLESTEROL. IN ADDITION, AN INDEPENDENT
COMMUNITY GUIDE REVIEW OF THE ECONOMIC EVIDENCE INDICATES THAT
TEAM BASED CARE FOR BLOOD PRESSURE CONTROL IS COST
EFFECTIVE. IMPLEMENTING THIS TYPE OF
MULTIDISCIPLINARY TEAM BASED APPROACH REQUIRES THE
ORGANIZATIONAL CHANGES OCCUR WITHIN THE HEALTHCARE SYSTEM.
THESE DATA REPRESENT THE ABSOLUTE PERCENTAGE POINT
INCREASE IN THE PROPORTION OF PATIENTS ACHIEVING BLOOD
PRESSURE CONTROL, AS WELL AS THE REDUCTION OF SYSTOLIC AND
DIASTOLIC BLOOD PRESSURE, INCLUDING ANOTHER TEAM MEMBER IN
PATIENTS CARE, IMPROVE PATIENT’S BLOOD PRESSURE CONTROL.
AND FOR TEAMS THAT INCLUDED PHARMACISTS THE MEDIAN
IMPROVEMENT IN THE PROPORTION OF PATIENTS WITH CONTROLLED BLOOD
PRESSURE WAS CONSIDERABLY HIGHER THAN THE OVERALL MEDIAN
INCREASE. MEDICATION MANAGEMENT ROLES FOR
TEAM MEMBERS DIFFERED ACROSS STUDIES IN THREE WAYS.
TEAM MEMBERS COULD PROVIDE ADHERENCE SUPPORT AND
HYPERTENSION RELATED INFORMATION, WITH NO DIRECT
INFLUENCE ON MEDICATION PRESCRIBING.
HOWEVER THE EFFECTIVENESS OF TEAM BASED CARE WAS GREATER WHEN
TEAM MEMBERS COULD CHANGE HYPERTENSIVE MEDICATIONS
INDEPENDENT OF THE PRIMARY CARE PROVIDER OR AFTER THE PROVIDER’S
APPROVAL OR CONSULTATION. YOU HAVE HEARD COLLABORATIVE
PRACTICE AGREEMENTS OR CPAs ARE FORMAL AGREEMENTS BETWEEN A
LICENSED PROVIDER AND A PHARMACIST.
FOLLOWING A JANUARY 2012 CONSORTIUM OF THOUGHT LEADERS
CDC IN PARTNERSHIP WITH THE AMERICAN PHARMACIST ASSOCIATION
FOUNDATION PRODUCED A SET OF TOOLS TO
SUPPORT THE IMPLEMENTATION OF CPAs, WHICH ARE A CRITICAL
FACTOR IN FACILITATING TEAM BASED CARE BETWEEN PHYSICIANS
AND PHARMACISTS. THESE TOOLS CUSTOMIZE A CORE SET
OF SEVEN RECOMMENDATIONS FOR FOUR DIFFERENT AUDIENCES WITH
STAKE IN IMPLEMENTING CPAs. THESE ARE PHARMACISTS, OTHER
HEALTHCARE PROVIDERS, PAYORS AND DECISION MAKERS SUCH AS
LEGISLATORS OR HEALTHCARE ADMINISTRATORS.
CDC INFUSED CASE STUDIES. ABOUT SUCCESSFUL INTEGRATION OF
CPAs. THE SEVEN KEY PRINCIPLES ARE TO
EMBED PHARMACIST SERVICES AND CPAs INTO PATIENT CARE
INFRASTRUCTURE, THAT SIMPLE, UNDERSTANDABLE AND EMPOWERING
LANGUAGE IS BEST WHEN REFERRING TO THE SERVICES AND THAT
HEALTHCARE PROVIDERS WHO WOULD ENTER INTO COLLABORATIVE
PRACTICE AGREEMENTS SHOULD DEFINE THE DETAILS OF EACH
AGREEMENT AND TO MAKE SURE BEST AGREEMENT AND TO MAKE BEST USE
OF STAFF SKILLS, SCOPE OF PRACTICE LAW, EDUCATIONAL
CURRICULA AND OPERATIONAL POLICY SHOULD BE REVIEWED TO PROMOTE
SYNERGY AND COLLABORATION. ADDITIONAL PRINCIPLES ARE TO PAY
FOR THE QUALITY OF CARE SERVICES BASED ON THE MEANINGFUL PROCESS
AND OUTCOME MEASURES. PROVIDE INCENTIVES AND SUPPORT
FOR ADOPTION OF THE ELECTRONIC HEALTH RECORDS AND USE OF
TECHNOLOGY IN PHARMACY CARE AND MAINTAIN STRONG, TRUSTING
RELATIONSHIPS AMONG PATIENTS, DOCTORS AND OTHER PROVIDERS AND
ENCOURAGE THOSE INDIVIDUALS TO PROMOTE PHARMACIST SERVICES.
THESE CAN BE ACCOMPLISHED BY USING THE SIMPLIFIED FRAMEWORK
YOU SEE HERE. ALIGN THE INCENTIVE, IMPROVE THE
OUTCOMES. CONTROL THE COST.
IN 2012 CDC’S NATIONAL CENTER FOR CHRONIC DISEASE PREVENTION
AND HEALTH PROMOTION ISSUED A PROGRAM GUIDE FOR PUBLIC HEALTH,
EXPLAINING HOW TO PARTNER WITH PHARMACISTS TO PREVENT AND
CONTROL CHRONIC DISEASES. THIS GUIDE HAS BEEN A CRITICAL
ELEMENT IN CONNECTING STATE HEALTH DEPARTMENTS WITH STATE
PHARMACISTS AND ORGANIZATIONS AND SCHOOLS OF PHARMACY.
KEY PARTNERS IN RALLYING HEALTHCARE SYSTEMS AND COMMUNITY
PHARMACISTS. THE GUIDE RALLIES OUT
— LAYS OUT INFORMATION THAT PUBLIC HEALTH
PARTNERS NEED TO UNDERSTAND. ONE OF THE KEY POINTS CONVEYED
IN THIS GUIDE IS THE ROLE OF THE PHARMACIST IS EXPANDED BEYOND
JUST DISPENSING MEDICATIONS AND IS EVOLVING INTO ACTIVE
PARTICIPATION IN CHRONIC DISEASE MANAGEMENT AS PART OF A TEAM
BASED CARE SYSTEM. IT POINTS STATE HEALTH
DEPARTMENTS TO SUCCESSFUL MODELS OF PRACTICE SUCH AS THE
ASHEVILLE PROJECT WHERE PHARMACISTS IMPROVE PATIENT
OUTCOMES WITH CLINICAL DIABETES AND REDUCE OVERALL HEALTH CARE
COSTS, AS WELL AS THE DIABETES TEN CITY CHALLENGE AND OTHER
STATE SUPPORTED PROGRAMS. CDC IS INVESTING IN PHARMACIST
BASED INTERVENTIONS. ONE WAY IS THROUGH THE FUNDING
OPPORTUNITY ANNOUNCED AND RELEASED IN 2013
FOR ALL 50 STATES AND THE DISTRICT OF COLUMBIA WHICH
OUTLINES AN APPROACH FOR MANAGER DIABETES, HEART DISEASE AND
OBESITY AND TO PROMOTE SCHOOL HEALTH.
THIS FIVE YEAR PROJECT SUPPORTS IMPLEMENTATION OF CROSS CUTTING
APPROACHES STATEWIDE, AND SPECIFICALLY NAMES PHARMACISTS
AS PART OF TWO OF THE INTENDED STRATEGIES FOR STATE HEALTH
DEPARTMENTS TO CONSIDER. ONE OF WHICH IS TO INCREASE THE
ENGAGEMENT OF THE NON PHYSICIAN TEAM MEMBERS IN HYPERTENSION AND
DIABETES MANAGEMENT AND HEALTHCARE SYSTEMS.
AND THE OTHER TARGETS COMMUNITY PHARMACIES WHO CAN BRIDGE THE
COMMUNITY AND CLINICAL LINKAGE BY BUILDING AND SCALING PROGRAMS
WHERE THEY PROVIDE MEDICATION AND SELF MANAGEMENT EDUCATION.
DURING LAST MONTH’S PUBLIC HEALTH GRAND ROUNDS,
YOU HEARD ABOUT PROGRESS MADE THROUGH THE MILLION HEARTS
CAMPAIGN. TEAM UP PRESSURE DOWN IS THE
PROJECT, AND OFFERS TIME SAVING RESOURCES TO
SUPPORT PHARMACISTS WHO ARE MANAGING PATIENTS WITH HIGH
BLOOD PRESSURE AND TIPS HOW TO TAILOR THE PROGRAM FOR ANY
PHARMACY SETTING. THERE ARE THREE TIERS OF
INVOLVEMENT. FROM SPREADING AWARENESS TO
INCREASING MEDICATION ADHERENCE TO PROVIDING BLOOD PRESSURE
COUNSELING AND TRACKING OUTCOMES.
THESE IMPLEMENTATION IDEAS, TOOLS AND RESOURCES OFFERED IN
TEAM UP PRESSURE DOWN, ARE CATERED TO THE TIER
PARTICIPATION THE PHARMACY CHOOSES. IN MONTANA THEY ARE
PROGRAM IS PROVIDING YEARLY FUNDING FOR UP TO TEN
COMMUNITIES WHERE PHARMACISTS FOCUS ON MEDICATION ADHERENCE
ISSUES AMONG PATIENTS WITH UNCONTROLLED BLOOD PRESSURE.
RECENTLY A PARTICIPATING PHARMACIST DESCRIBED IT AS
FEELING LIKE WE ARE PRACTICING PHARMACY AGAIN AND NOT JUST
DEALING WITH INSURANCE COMPANIES AND TRYING TO SURVIVE CONTINUED
CUTS IN REIMBURSEMENT. TURNING TO DIABETES THE NATIONAL
DIABETES EDUCATION PROGRAM IS A JOINT EFFORT BETWEEN NIH AND CDC THAT PROMOTES EARLY DIAGNOSES, IMPROVES MANAGEMENT AND OUTCOMES
AND PREVENT OR DELAYS ONSET OF TYPE TWO DIABETES IN THE U.S.
THIS EFFORT INVOLVES OVER 200 FEDERAL, STATE AND PRIVATE
SECTOR PARTNERS. THE PEA POD INITIATIVE,
PHARMACISTS, PODIATRISTS, OPTOMETRISTS AND DENTISTS
ENCOURAGES THEM TO NETWORK TOGETHER TO MANAGE DIABETES.
THINK RECENTLY RELEASED A TOOL KIT AND GIVES EACH DISCIPLINE A
QUICK COURSE ON THE OTHER AND RELATIONSHIP WITH MANAGING
DIABETES. MANY PAST MODELS HAVE ENGAGED
SELF INSURED EMPLOYER GROUPS THAT PAIR PHARMACISTS WITH
PATIENT BENEFICIARIES LEADING TO A NUMBER OF POSITIVE OUTCOMES
YOU HAVE HEARD ABOUT TODAY. FUTURE EXPANSION OF THESE MODELS
RELIES ON FINDING SUSTAINABLE METHODS OF REIMBURSEMENT.
RECOGNIZING PHARMACIST AS HEALTHCARE PROVIDERS AND
PROMOTING PATHWAYS FOR PHARMACISTS TO PRACTICE IN A
MANNER COMMENSURATE WITH THEIR TRAINING AT THE MEDICATION
EXPERTS OF THE HEALTHCARE TEAM. INTEGRITY INTEGRATION OF PATIENT
SET OF MEDICAL HOMES, AND ACCOUNTABLE CARE ORGANIZATIONS
IS ALSO IMPORTANT. BECAUSE EACH OF THESE SETTINGS
AIM TO COMPREHENSIVELY MANAGE A PATIENT’S CARE.
ADDITIONAL RESEARCH IS NEEDED TO IDENTIFY AND EVALUATE ALL THE
PHARMACIST PROVIDED SERVICES DELIVERED IN THESE PRACTICES.
THERE IS ALSO A HIGH NEED FOR FOCUSED IMPROVEMENT ON
TRANSITIONS OF CARE FOR PATIENTS AND ENSURING MEDICATIONS GET
PROPERLY RECONCILED UPON DISCHARGE, ESPECIALLY FOR
PATIENTS AT HIGH RISK OF REHOSPITALIZATION.
FUTURE RESEARCH SHOULD CONTINUE TO EVALUATE THE THERAPEUTIC AND
ECONOMIC EFFECTS OF MEDICATION RECONCILIATION PROVIDED BY
PHARMACISTS. COMMUNITY PHARMACIES ARE
CONVENIENT AND ACCESSIBLE SETTINGS WHICH PATIENTS CAN
OBTAIN A WHOLE HOST OF PREVENTIVE SERVICES FROM
IMMUNIZATIONS TO DISEASE SELF MANAGEMENT COACHING.
YOU HAVE HEARD TODAY ABOUT MODELS THAT APPLY TO CHRONIC
DISEASE LIKE DIABETES AND HYPERTENSION.
OTHERS SPAN, DEPRESSION, CANCER, ANTI-MICROBIAL STEWARDSHIP AND
HIV MANAGEMENT AND SCREENING. A CRITICAL PLACE FOR PHARMACISTS
TO MAKE AN IMPACT IS WITH MEDICALLY UNDER SERVED AREAS AND
PLACES WHERE IS MAJOR HEALTH DISPARITIES EXIST.
CDC’S DIVISION OF HIV AIDS PREVENTION RECENTLY PUBLISHED
RESULTS FROM A PILOT OF 21 COMMUNITY PHARMACIES AND RETAIL CLINICS THAT PERFORMED HIV TESTING AND FOUND IT TO BE A FEASIBLE MODEL FOR RAPID
TESTING. ACCESS TO HEALTHCARE AND HIV
RELATED STIGMA MAY PREVENT SOME INDIVIDUALS FROM BEING TESTED.
CDC SEEKS TO LEARN WHETHER EXPANDING HIV TESTING TO
COMMUNITY PHARMACIES WILL PROVIDE HELP WITH OVERCOMING THE
OBSTACLES OF ACCESS TO CARE AND STIGMA, FOR INDIVIDUALS LIVING
WITH AND AT RISK FOR HIV INFECTION.
TO SUMMARIZE WHAT’S BEEN COVERED TODAY, IN ORDER TO ACHIEVE MORE
ACCESSIBLE, HIGHER QUALITY CARE THAT’S MORE COST EFFECTIVE,
PHARMACISTS WILL SERVE INCREASINGLY IMPORTANT ROLES AS
HEALTH CARE PROVIDERS, CARE TEAM MEMBERS, AND PUBLIC HEALTH
PROFESSIONALS. WE’RE ON THE RIGHT TRACK, AND
CDC OFFERS MANY RESOURCES TO ENSURE PHARMACISTS GO FROM BEING
UNDERUTILIZED TO OPTIMALLY UTILIZED HEALTH CARE
PROFESSIONALS. I WOULD LIKE TO THANK EVERYONE
FOR JOINING THE GRAND ROUNDS SECTION.
I INVITE THE AUDIENCE TO ASK QUESTIONS.
WE WILL TAKE QUESTIONS FROM THE AUDIENCE AND THE SOCIAL MEDIA
AUDIENCE. SO THANK YOU.
[ APPLAUSE ] WE WILL TAKE QUESTIONS FROM
SOCIAL MEDIA. ARE PHARMACISTS ABLE TO
INTERVENE IF A CUSTOMER IS BECOMING ADDICTED TO
PRESCRIPTION MEDICATIONS, AND IF YES, HOW.
>>ABSOLUTELY. PHARMACISTS ARE AT THE
FRONT LINES AS WE SAID, SITUATIONS WHERE PATIENTS MAY BE
TAKING MEDICATIONS IRRESPONSIBLY, AND WE KNOW THAT
THE PUBLIC HEALTH EPIDEMIC OF OPIOID AND OTHER PRESCRIPTIONS
IS PROFOUND. PHARMACISTS HAVE MANY TOOLS AT
THEIR DISPOSAL, BOTH THEIR PERSONAL RECOGNITION OF WHEN A
PATIENT IS OVERUSING PRESCRIPTIONS TO CONTACT THEIR
PROVIDER AND ALERT THEM TO THE PROBLEM.
THERE’S ALSO PRESCRIPTION INCLUDING MONITORING DATABASES
AVAILABLE THAT PHARMACISTS CAN TRACK WHERE PEOPLE MAY BE
OBTAINING THEIR PRESCRIPTIONS, IF NOT AT THEIR PHARMACY BUT
OTHER PHARMACIES. SO THEY CAN BETTER DETECT THESE
ISSUES. SO CERTAINLY PHARMACISTS ARE
ABLE TO AND DO QUITE OFTEN MAKE INTERVENTIONS AROUND THAT VERY
BURDENSOME ISSUE. WE HAVE A QUESTION FROM THE
AUDIENCE. GO AHEAD.
>>IS THIS WORKING? THERE YOU GO.
>>YOU MENTIONED THE INCREASING COMPLEXITY OF MEDICAL CARE.
I THINK WE’VE HAD AN INCREASE IN COMPLEXITY IN THE LAST FEW
MONTHS WITH THE EBOLA OUTBREAK. I’VE READ IN THE LAST FEW DAYS
THAT THERE WAS A PATIENT, OR PERSON, WHO WENT TO ONE OF THE
URGENT CARE CLINICS IN ONE OF THE PHARMACIES IN BRAIN TREE
MASSACHUSETTS. AND I THINK THAT REFLECTS THE
FACT THAT PHARMACIES, ESPECIALLY THE CHAINS ARE GETTING INTO THE
BUSINESS OF URGENT CARE. AND I GUESS I HAVE A COUPLE OF
QUESTIONS RELATING TO THAT. ONE, HOW DOES THAT RELATE TO THE
PHARMACY PART? IS URGENT CARE TOTALLY SEPARATE,
OR WHO OVERSEES URGENT CARE? I IMAGINE THE URGENT CARE
PROVIDERS ARE GOING TO BE SOMETHING LIKE NURSE
PRACTITIONERS AND PHYSICIANS. AND I THINK THERE ARE MANY
BENEFITS TO PHARMACY URGENT CARE PROVIDERS.
ONE IS THE EASY ACCESS THAT IS LESS EXPENSIVE THAN AN EMERGENCY
ROOM. AND PEOPLE WHO MAY BE A LITTLE
EMBARRASSED IF THEY HAVE BEEN EXPOSED, SAY, TO EBOLA, THEY
MIGHT HAVE A LITTLE BIT MORE ANONYMITY IN A SETTING LIKE
THAT. SO I THINK THAT MAY BE AN
ATTRACTIVE PLACE FOR PERSONS WHO HAVE FOR EXAMPLE COME FROM WEST
AFRICA OR BEEN EXPOSED TO PATIENTS TO COME.
IS THERE GOING TO BE A PROVISION TO, FOR EXAMPLE, PUT AN
ISOLATION ROOM IN THESE URGENT CARE PARTS OF THE PHARMACY,
WHERE A SUSPECT WHOSE AT HIGH RISK?
ALSO IS THERE GOING TO BE SCREENING OF PATIENTS FOR THEIR
EXPOSURE? I KNOW THIS IS PROBABLY
SOMETHING THAT PHARMACISTS HAVE NOT CONSIDERED BUT I THINK WE’RE
ALL GOING TO BE FACED WITH HAVING TO RECONFIGURE HOW WE DO
MEDICINE IN THIS AGE OF EBOLA. SURE.
I THINK ANN WOULD LIKE TO ANSWER THAT.
>>TILE TAKE AT LEAST PART OF — I’LL TAKE A STAB AT PART OF
IT. IN ANSWER TO YOUR QUESTION ABOUT
THE CONNECTION BETWEEN URGENT CARE CENTERS AND THE PHARMACY,
WHAT WE SEE REALLY HONESTLY IS VARIABILITY IN THE MARKETPLACE.
IN SOME PLACES IT SEEMS LIKE THE PHARMACISTS THAT ARE WORKING IN
THE PHARMACY, WHICH OFTEN HAVE PRIVATE CONSULTATION AREAS
THEMSELVES, MAY HAVE A GOOD RELATIONSHIP AND A CONSISTENT
COMMUNICATION BACK AND FORTH. AND IN OTHERS IT SEEMS LIKE IT
IS NOT AS PREDOMINANT. SO THE — IT IS VARIABLE, IS THE
ANSWER TO THAT QUESTION. I CAN’T ANSWER WHETHER OR NOT
THE CLINICS ARE CONSIDERING PUTTING IN ISOLATION AREAS.
BUT I WOULD ALSO REMARK THAT A LOT OF PATIENTS PRESENT TO
PHARMACISTS WITH SYMPTOMS THAT COULD MIMIC THE BEGINNING STAGES
OF EBOLA. SO IT IS ALSO VERY IMPORTANT NOT
ONLY FOR THOSE URGENT CARE CLINICS BUT ALSO FOR PHARMACISTS
WHO ARE WORKING IN COMMUNITY PHARMACIES TO BE IN TUNE TO THE
SYMPTOMS AND ASK THE RIGHT QUESTIONS AND REFER THOSE
PATIENTS. AND WE HAVE ANOTHER QUESTION
FROM AN AUDIENCE MEMBER. I WANT TO THANK THE SPEAKERS
FOR OUTLINING NICELY A CASE FOR USING CLINICAL PHARMACY SERVICES
TO IMPROVE PUBLIC HEALTH, OUTLINING SOME OF THE TOOLS
AVAILABLE AND OPPORTUNITIES OF THE CHANGING HEALTHCARE SYSTEM.
ARE THERE WAYS TO MEASURE GOING FORWARD IF MORE PHARMACISTS ARE
ENTERING THIS KIND OF CLINICAL PRACTICES EITHER UPON GRADUATION
OR IN THE WORKFORCE NOW? GREAT QUESTION.
THERE ARE SEVERAL DIFFERENT SURVEYS THAT TAKE PLACE ON A
REGULAR BASIS. PHARMACIST WORKFORCE SURVEYS.
AND THERE IS ONE JUST COMPLETING AND WILL BE RELEASED I BELIEVE
IN MARCH. AND SO IT IS A TOPIC OF
SIGNIFICANT INTEREST WITHIN THE PHARMACY PROFESSION.
AND FROM THE DATA WE’RE SEEING IT IS INCREASING.
A LOT OF PHARMACISTS ARE IN MIXED POSITIONS OR MELDED
POSITIONS, WHERE THEY MAY HAVE SOME DISTRIBUTIVE FUNCTIONS BUT
THEN ALSO CLINICAL RESPONSIBILITIES.
WE’RE SEEING A LOT OF THAT. BUT YEAH, THERE IS A SIGNIFICANT
EFFORT TO TRACK UPTAKE. THANKS.
AND WE HAVE TIME FOR ONE MORE QUESTION.
AND THIS WILL COME FROM A SOCIAL MEDIA AUDIENCE.
>>ARE PHARMACISTS RESPONSIBLE FOR KNOWING OR ABLE TO KNOW ALL
DRUGS THE PATIENT HAS USED OR IS PRESCRIBED FOR POSSIBLE
INTERACTION? AS WE EXPLAIN THE MEDICATION
THERAPY MANAGEMENT SERVICES, ONE OF THE THINGS THAT IS DONE
DURING THAT VISIT IS REALLY TO GET A COMPLETE DRUG HISTORY.
SO PART OF WHAT WE DO IS MAKING SURE THAT THE PATIENTS WE ASK
AND DOCUMENT EVERY MEDICATION TAKEN INDEPENDENTLY THEY GET IT
IN THAT PARTICULAR PHARMACY OR SOMEPLACE ELSE.
AND ALSO TO DOCUMENT ALL HERBAL, OVER THE COUNTER OR MEDICATIONS
THEY ARE TAKING IN THE PROCESS IS ONCE THAT INFORMATION IS
COLLECTED IS FOR THE PHARMACIST TO ACCESS IF THERE ARE ANY DRUG
INTERACTIONS OR ANY POTENTIAL FOR THAT PATIENT NOT TO BE
ADHERENT WITH THAT MEDICATION. SO THE ANSWER IS YES.
IF YOU DO GO THROUGH THE PROCESS OF THE MEDICATION THERAPY
MANAGEMENT YOU SHOULD BE ABLE NOT ONLY TO COLLECT INFORMATION
BUT ALSO ASSESS AND MAKE THE APPROPRIATE RECOMMENDATIONS.
>>AND COMMANDER LEE’S PERSPECTIVE MAY BE A LITTLE
DIFFERENT FROM THE FEDERAL SIDE OF THINGS.
WOULD YOU LIKE TO ADD ANY COMMENTS TO HERS?
>>IN OUR SETTING, PATIENTS COME TO OUR SETTING IN THE INDIAN
HEALTH SERVICE AND RECEIVE A VAST PERCENTAGE OF THEIR CARE AT
THAT FACILITY. SO IT DOES IMPROVE THE PROCESS
OR THE ABILITY TO OBTAIN THAT INFORMATION BECAUSE OF OUR
SYSTEM WITHIN THE SYSTEM. AGAIN, WE DO HAVE THOSE PATIENTS
THAT ARE TAKING THOSE OUTSIDE MEDICATIONS AS WELL AS OVER THE
COUNTER ITEMS. SO WITHIN OUR CLINICAL PROGRAMS
WE DO ASCERTAIN ON EVERY ENCOUNTER WHAT OTHER MEDICATIONS
THAT A PATIENT IS TAKING. SO THAT WAY WE CAN IDENTIFY
THOSE DRUG INTERACTIONS OR OTHER RECOMMENDATIONS THAT WE NEED TO
MAKE FOR THAT PATIENT’S CARE. THANK YOU AGAIN VERY MUCH TO
OUR SPEAKERS. AND WE’LL SEE OUR AUDIENCE LIVE
OR ON THE WEB IN ONE MONTH’S TIME FOR THE NEXT PUBLIC HEALTH
GRAND ROUND. [ APPLAUSE ]

1 thought on “CDC Grand Rounds: How Pharmacists Can Improve Our Nation’s Health

Leave comment

Your email address will not be published. Required fields are marked with *.