Jul Aug 2008 APN.pdf - AACP

feature s t o r y
University of
Nebraska Medical
Center College of
Pharmacy
40
Grand Island is a
rural community in
central Nebraska;
the high ratio of
cattle to people is
significant and grain
farming is the major
industry. Little is
known about pharmacy medication therapy management services,
that is, unless you are a United States veteran.
The Grand Island Veteran’s Affairs (VA) Medical Center is an
advanced practice site for clinical pharmacy services and serves
as a major clerkship location for the University of Nebraska
Medical Center (UNMC) College of Pharmacy. Pharmacists
provide more than 1,200 clinical visits to veterans monthly in
addition to long-term care services. The practice has grown
over recent years to include two full-time clinical pharmacy
specialists, two co-funded UNMC faculty, three pharmacy
(PGY1) residents and three to five pharmacy clerkship students
monthly.
Clinical pharmacists at the Grand Island VA have expanded
scopes of practice that include electronic referral, lab ordering
and medication prescribing. The primary practice areas are
hyperlipidemia, anticoagulation, smoking cessation, COPD,
prediabetes, diabetes mellitus and hypertension. Pharmacists
also participate in general medication consults and are highly
involved with non-formulary medication prescribing processes.
Clinical services provided to the long-term care unit include
medication review, reconciliation, pharmacokinetics, smoking
cessation, interdisciplinary meetings and daily rounds with
providers.
All veterans new to the facility (in-patient and ambulatory) receive
an extensive medication history review with therapeutic
recommendations provided to the primary provider. This process
has reduced new non-formulary medication requests.
Pharmacy students have the responsibility of reviewing a patient’s
medication history, developing a therapeutic plan with
their assigned clinical pharmacist and finally seeing the patient.
At the end of the visit, the clinical pharmacist is brought
into the room for final assessment and implementation of the
therapeutic plan.
Afternoons are spent in sessions with the clinical faculty discussing
cases, working on assigned projects and completing
therapeutic reviews. Pharmacy residents (PGY1) who complete
a longitudinal program also have opportunities to precept
students and provide training sessions. The program has
proven desirable as every year the number of students applying
for the site exceeds the available slots.
academic Pharmacy now Jul/Aug/Sept 2008
The University
of New Mexico
College of
Pharmacy
The University of
New Mexico (UNM)
College of Pharmacy
and the New Mexico
Medical Review Association
(NMMRA),
New Mexico’s Medicare
quality improve-
ment organization, have launched the statewide New Mexico
Prescription Improvement Coalition (NMPIC) and are working
together on multiple Medicare Part D quality initiatives. NMPIC
members include many Medicare Part D stakeholders nationally
and throughout New Mexico including UNM College of Pharmacy,
NMMRA, multiple health plans, the New Mexico Pharmacists
Association, the New Mexico Society of Health-System
Pharmacists, New Mexico Medicaid, and community pharmacists
and physicians. NMPIC is focusing on two projects: a statewide eprescribing
pilot and a medication therapy management (MTM)
pilot.
NMPIC has created the New Mexico MTM Collaborative based
on successful efforts and methodology that have been undertaken
by the Institute for Healthcare Improvement as well as tenets of
continuous quality improvement. The collaborative is focusing on
Medicare beneficiaries with two or more of the following disease
states: diabetes, hypertension, hyperlipidemia and congestive
heart failure (CHF).
The project is comparing health outcomes over one year between
a face-to-face MTM group and a usual care group. The primary
objective is to assess medication adherence. Secondary objectives
are to evaluate the following: 1) the impact of face-to-face MTM
on self-reported health outcomes and quality-of- life measures
obtained from the SF-12 survey; 2) the impact of face-to-face
MTM on healthcare utilization (i.e., emergency department visits,
hospitalizations and outpatient visits); and 3) the impact of
face-to-face MTM on disease-specific clinical outcomes, including
A1C, blood pressure and low-density lipoprotein.
The health literacy of the beneficiaries is also being evaluated and
these results are being used to modify the education provided by
the pharmacists. Patients randomized to the face-to-face MTM
group will have an initial one-hour visit, and then will have up
to three 30-minute, follow-up visits, and up to eight follow-up
telephone calls as needed over the 12-month period. The usual
care group will have a baseline and a 12-month visit to complete
surveys and measure vital signs.
Participating pharmacists are completing live and Web-based
training sessions on medication adherence, motivational interviewing,
disease management updates, health literacy and MTM
documentation to ensure consistency among the pharmacists and
to share best practices. Because adherence with national treatment
guidelines for chronic illnesses is low, the project also hopes
to improve treatment guideline adherence along with patient
medication adherence through pharmacist training. Pharmacists
will be reimbursed for the time that they spend with patients.
The Ohio State
University
College of
Pharmacy
A young mother walks up to the
prescription drop-off window at
her local Kroger pharmacy. The
pharmacist behind the counter
greets her by name as she hands
over a prescription.
“Your son’s still got that ear infection?”
he says as he types up her information.
They talk about cough medications, decongestants and potential side effects
of the antibiotic being prescribed. She asks him if antibacterial hand wipes are
truly effective in preventing the spread of illness.
Welcome to the new face of pharmacy, where quality practice is as much about
communicating with patients as it is about dispensing medication.
To Dr. Jennifer Rodis, assistant professor of clinical pharmacy, the changing
role of the community pharmacist is an exciting development she is passionate
about promoting. For the past three years, she has coordinated a program
called Partner for Promotion, which pairs fourth-year pharmacy students with
community pharmacists to develop patient education materials, health screenings
and other services.
The idea to create the program, Rodis said, was a no-brainer. “Who do we see
more often than anyone else in the healthcare profession? It’s our pharmacist,”
she said.
“In the last five to 10 years, we’ve been seeing a real trend: People are seeing
multiple physicians, they’re not affording their medications so they’re not taking
them, and then they’re not sure why they’re taking the pills they do take,”
Rodis said.
Working with two other faculty—Drs. Julie E. Legg and Kristin A. Casper —
and funding from an Excellence in Engagement grant, Rodis made the program
a vehicle for helping pharmacists and pharmacy students develop resources
and procedures for providing patient care services.
For 10 months, one or two Ohio State pharmacy students work closely with a
community pharmacist, from a Kroger or CVS pharmacy to an independent
business like Foster’s Pharmacy in Mount Vernon, Ohio, to identify patient
education needs — cholesterol screening and education, hypertension adherence
programs and diabetes screening and education, for example — and create
an advanced patient care service.
“We have a set of online education modules that follow a step-wise approach
to developing the patient care service. They’re not the clinical information or
therapeutic information on a disease or the drugs, because for the most part
the pharmacists already have that,” Rodis said.
Since 2005, the program has helped implement services in 19 sites across central
Ohio and parts of Kentucky.
Rodis is proud of a program she says no other college of pharmacy can quite
match. At other schools, she explains, it’s typically the faculty who go into the
pharmacies, create programs and then let the pharmacists run it. At Ohio State,
the hope is that by having pharmacists work with students to develop patient
care services specific to their pharmacies, there will be more ownership of that
service and a deeper understanding of the process behind creating it.
University of
Washington
School of
Pharmacy
feature s t o r y
The Washington State Department of Health
Board of Pharmacy recently granted the UW
School of Pharmacy a license to open a nondispensing
MTM pharmacy. It is one of the first of
its kind in Washington state.
This new pharmacy is an integral component of
the Department of Pharmacy’s effort to develop
an MTM training program within the school.
Drs. Annie Lam and Peggy Odegard, named Herb
and Shirley Bridge endowed professors this past
fall, are using the funds from the professorship
to create this program. Lam and Odegard saw a
need for it after learning that some Washington
pharmacists have been overwhelmed by MTM requests
since Medicare Part D went into effect in
January 2006. Given that pharmacy students have
also requested MTM training in recent years, this
seemed like the right time to pursue this project.
The school is collaborating with the Washington
State Pharmacy Association to bridge the service
gap for practitioners who have more requests for
these Medicare-related services than they can
satisfy. Ultimately, the program seeks to help
community pharmacists meet the demand while
also creating an effective teaching resource for
the School of Pharmacy.
“Our goal is not to be competitive with our professional
colleagues who are practicing pharmacists,
but rather to provide them with MTM
support while also assuring our graduates are
well-prepared to provide these services,” says
Odegard.
The School of Pharmacy’s MTM program will
focus on three primary areas — implementing
an MTM curriculum for students, creating an
onsite MTM consulting service and conducting
research.
Some of the initial research, says Odegard, will
assess best practices for pharmacists providing
these services to older adults. If all goes according
to plan, the school will begin offering the
training classes to students this fall.
academic Pharmacy now Jul/Aug/Sept 2008 41