Scope of Practice

How embedded pharmacists improve care for Native American patients

Sara Berg, MS , News Editor

Compared with other U.S. population groups, Native American communities experience growing inequities in health care outcomes. This is due in part to inadequate access to comprehensive health services. To help address this gap, the Red Lake Indian Health Service (IHS) Hospital developed a solution: embed pharmacists into the health care team.

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By embedding pharmacists in the primary care setting, the Red Lake IHS Hospital aims to expand access to care and improve health outcomes for Native American patients. The hospital is a small, rural facility located on the Red Lake Reservation in northwest Minnesota and serves an intertribal population of about 10,000 Native American patients. Some documented health inequities include rates of chronic disease, cancer prevalence, unintentional injuries and infant mortality.

In 2012, the hospital employed 11 clinical pharmacists, primarily providing traditional pharmacy dispensing services. However, the facility was facing a shortage of primary care physicians, limited patient care access, and concerns about the chronic disease burden. To address these matters, the Red Lake medical staff decided that a patient-centered, team-based care approach could be enhanced through the Pharmacy Primary Care Clinic (PPCC) services.

“With the aim of improving patient care, the goal of the service would be to: expand patient access to care, allow for timely follow-up appointments, maximize medication safety and monitoring, improve patient satisfaction, consistently meet facility quality indicators and improve patient care outcomes,” wrote United States Public Health Service Captain Christel Svingen, PharmD, who serves as the Deputy Pharmacy Director at the Red Lake IHS Hospital.

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Clinical pharmacists focused on improving patients’ blood pressure, lipids, diabetes and immunization outcomes through comprehensive medication management.

After the initial service expansion, the pharmacists’ role was enhanced further to focus on nicotine addiction, asthma, chronic obstructive pulmonary disease, spirometry, anticoagulation, hypothyroidism, naloxone co-prescribing and behavioral health. These were all added to the PPCC collaborative practice agreement.

Pharmacists were also able to interact further with patients at the hospital. While practicing within this clinical service, pharmacists conducted patient assessments and ordered medications. They also assisted with ordering and interpreting labs, creating referrals for other clinical services, and coordinating care.

Another area of focus for pharmacists expanded to educating patients on treatment plans. This helps to ensure patients understand their treatment and can properly follow the prescribed plan.

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“The pharmacists worked hard to establish trust and collaborate with patients and providers within the new clinical role,” wrote Capt. Svingen. “Collaborative practice agreements, workflow processes, patient access policies, visit documentation and reimbursement models were developed to ensure the quality of pharmacist delivered clinical services and sustainability of clinical services.”

To meet department and clinic standards, the team also enhanced clinical competency to include certification requirements such as board or National Clinical Pharmacy Specialist certification.

Pharmacists’ approaches to care also saw a shift. They added a focus on health and wellness, motivational interviewing, meeting patient needs and collaborative goal-setting with patients.

The outcomes, quality assurance and performance improvement were critical to demonstrating that pharmacists positively impact patient health outcomes at the Red Lake Indian Health Service Hospital.

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.