Primary care physicians (PCPs) working in an institution in North Carolina face many of the same problems common to practices throughout the country. They care for an aging patient population and address the challenges associated with multiple comorbidities and complicated therapeutic regimens. The difference, though, is these physicians work exclusively with patients who are incarcerated. To improve outcomes in incarcerated populations, embedded pharmacists have become part of the care team.

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In the early 2000s, pharmacists were brought in as part of an integrated care team to aid PCPs with patient care. With the help of embedded pharmacists, the Federal Correctional Complex in Butner, North Carolina (FCC Butner) continues to address specific therapeutic activities that had been consuming large amounts of physician time. FCC Butner is a multi-facility complex within the Federal Bureau of Prisons. It consists of five different facilities with varying levels of security designation and specialty populations, including specific medical missions such as oncology and mental health.

The medical center can accommodate any level of security and the most complicated medical patients while the surrounding complex houses patients with significant medical needs. Each facility is serviced by separate teams of PCPs, physician assistants and nurse practitioners. However, the same pharmacist team operates throughout the complexes.

“As part of practicing medicine with a complex population, PCPs would spend considerable time researching answers to questions which they found readily in a phone call to the pharmacy,” says the success story from the AMA STEPS Forward™ module on embedding pharmacists, written by authors from the United States Public Health Service (USPHS). Learn more about how the USPHS uses embedded pharmacists to improve care for Native American patients.

This led to physicians asking, “Why not have the pharmacist conduct patient interviews, assess lab results, and make therapeutic adjustments with the oversight of the primary care physician?” Here is how embedded pharmacists at FCC Butner have helped improve correctional health care.

For the transition from consultants to care providers, pharmacists at FCC Butner established collaborative practice agreements (CPAs) in specialized areas such as HIV and pain management. Pharmacists specializing in specific disease states then pursued additional education and credentialing.

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A tool that offered a recognizable standard of care for pharmacists was the National Clinical Pharmacy Specialist (NCPS) certification. If a physician had concerns about oversight of clinical pharmacists, they were able to reference the NCPS certification that listed clear expectations. The NCPS committee reviews CPAs to ensure processes are standardized within a pharmacist-managed clinic. This also helps to ensure outcomes relative to the care provided are collected each year.

Learn more from the AMA about how to make the pharmacist part of your practice’s team.

The pharmacists at FCC Butner and within the Federal Bureau of Prisons maintain a firm understanding of disease states and available therapies. More importantly, though, they also possess a greater understanding of the unique challenges and opportunities faced by living in the prison environment.

“Specialty consultation by providers outside the prison system is available for patients,” says the success story. . “However, it is advantageous to the patient to work with providers who are already familiar with the unique opportunities and challenges of living in incarceration.” 

Pharmacists at FCC Butner are available to offer secure and timely follow-up care, minimizing risks and wait times.

Learn more about how adding a pharmacist to the team can improve patient outcomes.

As physicians became comfortable with pharmacists as part of the care team, FCC Butner was able to expand services further. By early 2010, comprehensive diabetes management services were created using a pharmacist-physician partnership. This was outlined by a CPA that met NCPS certification criteria.

If a high-risk patient had an A1c of more than 9%, the physician referred them to the pharmacist who would discuss blood glucose, cardiovascular risk reduction, immunizations, and other aspects of comprehensive diabetes care.

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“Diabetes management requires an intensive understanding of a patient’s daily life to provide appropriate counseling and planning related to exercise and dietary choices,” says the success story. “Pharmacists working within the prison are particularly well-suited to appreciate the opportunities and challenges presented by the environment and culture.”

For example, needles and syringes are meticulously accounted for in an incarcerated environment. This requires insulin therapy administered as Directly Observed Therapy during designated times at each facility. Additionally, pharmacists are aware of the food available for sale in institutional commissaries, can recommend recreational activities and understand how security concerns can impact daily routines.

“The pharmacists at FCC Butner have proven their value in assisting physicians and patients in pursuit of their health goals,” says the success story. “As pharmacists working at FCC Butner have demonstrated the benefits of their work within primary care practice, there may be other practices for whom unique cultural understandings are better appreciated by local pharmacists relative to outside specialty consultants.”

Physicians can learn more about embedding pharmacists within their practice through the AMA’s STEPS Forward™ open-access modules, which offer innovative strategies that allow physicians and their staff to thrive in the new health care environment. These courses can help you prevent physician burnout, create the organizational foundation for joy in medicine and improve practice efficiency.

The CME module, “Embedding Pharmacists Into the Practice,” 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.

The module is part of the AMA Ed Hub™, an online platform with high-quality CME and education that supports the professional development needs of physicians and other health professionals. With topics relevant to you, it also offers an easy, streamlined way to find, take, track and report educational activities.

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