The addition of a pharmacist into a team-based care practice model can improve patient outcomes. As key partners in patient care, pharmacists take on a variety of roles, such as helping get a patient’s diabetes or hypertension under control.
At Providence Medical Group in Oregon, pharmacists have been part of the team for more than 20 years, helping, for example, to manage insulin and other medications for patients with diabetes.
Providence grew from one to 21 pharmacists in about 43 patient-centered medical homes. Many clinics have a full-time embedded pharmacist, while others share, depending on the size of the practice. With more than 15 collaborative practice agreements and based on the unique patient panel of each clinic, pharmacists target conditions such as diabetes, hypertension, heart failure and asthma.
“The idea was that physicians needed help with complex medication regimes. We started very small with a few number of PharmDs that would be available for answering medication questions. Then found it was useful to have [a pharmacist] within the clinic,” said Deborah Satterfield, MD, a primary care physician and area medical director at Providence Center. Medical Group.
Providence’s process for making pharmacists part of their team-based care model can also be seen in an AMA STEPS Forward™ module. This free online module explains how to determine the pharmacy needs for a physician’s health care team and how to identify the right type of support for their practice and patient panel.
Here is how collaboration with pharmacists has helped Providence Medical Group in Oregon for more than two decades.
Within each practice, the pharmacist’s roles will vary somewhat, depending on the clinic’s specific needs and patient panel.
Pharmacists can help with insulin treatment, virtual consults and diabetes management, said Lori Gluck, MD, a family physician who is medical director of the group’s clinic Bethany, Oregon. Other roles include follow-up visits for hypertension and depression, new medication starts, medication tapering including opiates, and review of polypharmacy issues in elderly patients.
“Our pharmacist follows most of our patients with diabetes whose disease is not under control. She helps with insulin management and titration, and medication management in general for diabetes patients,” said Dr. Gluck. “She [also] helps at our care conferences and presents topics at our clinic meetings. She is invaluable. We all love having her.”
Physicians can also refer to pharmacists to answer patient calls or emails about medication-related questions. This helps to free up time for the physician who might require added time to look up answers.
The largest population seen by pharmacists at this medical group is patients with diabetes, said Kristy Butler, PharmD, manager of clinical pharmacy specialists in the clinical pharmacy department at Providence Medical Group. Pharmacists will work closely with patients and will often take the time to call patients every week if their diabetes is in poor control.
“It is interesting because we try to get our poorly controlled patients with diabetes to the behaviorist, but they are often more receptive to seeing the pharmacist first,” said Dr. Satterfield. “After some work with [the pharmacist], we can get them to the behaviorist if they are still resistant.”
For example, her practice was struggling with a patient for years and could not get her hemoglobin A1c below 11 percent. The patient’s illiteracy posed a barrier to care. To help, the pharmacist created medication lists and diabetes tools with pictures. Within six months of working with the pharmacist, the patient’s levels were in control.
And in Dr. Gluck’s office, the pharmacist has also been “tremendous” with difficult diabetes patients and insulin management. The pharmacist will perform challenging medication adjustments, which has made a big difference for patients with type 2 diabetes who need help with insulin.
“I feel very strongly that [pharmacists] are an integral part of the team,” she said. “Once you practice with a clinical pharmacist at your fingertips, I can’t imagine not having that service.”
The AMA’s STEPS Forward™ collection offers free online modules that help physicians and system leaders improve well-being, including learning about the organizational changes that lead to physician satisfaction and improving resiliency.
Several modules have been developed from the generous grant funding of the federal Transforming Clinical Practices Initiative (TCPI), an effort designed to help clinicians achieve large-scale health transformation through TCPI’s Practice Transformation Networks.
The AMA, in collaboration with TCPI, is providing technical assistance and peer-level support by way of STEPS Forward resources to enrolled practices. The AMA is also engaging the national physician community in health care transformation through network projects, change packages, success stories and training modules.