Ocean Health Initiatives Patient Safety Pharmacy Collaborative M.E.D.S

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Ocean Health Initiatives Patient Safety Pharmacy
CollaborativeM.E.D.S
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OCEAN HEALTH INITIATIVES2009

• FQHC located in Ocean County, NJ
• Sites located in Toms River and Lakewood
• Mobile Van
• 18,866 Patients were served
• 8,100 Hi Risk Patients
• 2,481 Diabetic Patients
• 3,495 Hypertensive Patients

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OCEAN HEALTH INITIATIVES

• M.Medication
• E. Education
• D.Drug
• S. Safety

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M.E.D.S Team Members

• Theresa Berger, CEO
• Shira Meyer, MD
• Pranathi Mandadi, MD
• Jigna Desai, Pharmacist
• Rosemary Faughnan, RN
• Linda Whitfield-Spinner
• Kathleen Dagato, ANP
• Michelle Hutchinson, LPN
• Lynn Walker, LPN
• Israel Arroyo, Medical Assistant
• Ramdra Villanueva, Medical Assistant
• Kriscia Ramirez, Med Tech
• Hannah Maldony, RN DON
• Carmen Mallamaci, MD CMO

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Partner Organizations

• Community Medical Center
• Provides Pharmacist
• New Jersey Primary Care Association
• Team Member Provides Guidance and Resources
• Labcorp
• Provides discounted fees for uninsured patients

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PSPC Aim Statement

• Implementation of Clinical Pharmacy Services for
  our highest risk Diabetic Patients who are
  experiencing Hypertension out of control
• Goals
• Improve Health Outcomes
• Improve Pharmacy Access
• Improve Patient Safety and Adherence

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What are Clinical Pharmacy Services?

• Patient-centered services that promote the
  appropriate
• selection and utilization of medications to
  optimize individualized therapeutic outcomes
• Provided by an inter-disciplinary healthcare
  team
• through individualized patient assessment and
• management
• Services best provided by a pharmacist or by
  another
• healthcare professional in collaboration with a
  pharmacist

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Clinical Pharmacy Services Elements

• Medication Access Services to Patients
• Patient Counseling
• Preventive Care Programs
• Drug Information Services to Patients
• Medication Reconciliation Services
• Provider Education
• Retrospective Drug Utilization Review
• Medication Therapy Management
• Disease State Management
• Prospective Chart Review and Provider Consultation

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1. Medication Access Services to Patients

• Utilization of Drug Programs Strategies (340B
  Prime Vendor participation, partnerships with
  charitable other outside payer groups,
  enrollment assistance for patients into programs
  that increase access such as Medicare part D or
  Medicaid, etc.) with the goal of obtaining a
  sustainable source of medications for patients
  that will improve access to care.
• Recommend generic alternative
• Patient Assistance Program

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2. Patient Counseling

• Patient routinely interacts with a licensed
  health care provider when medication is picked
  up.
• Follow up phone call from nurse/ma/pharmacist

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3. Preventive Care Programs

• Measure appropriate indicator (BMI, waist
  circumference, BP, health questionnaire, etc)
  and/or administer CLIA Waived test during
  individual or group screening encounters in order
  to identify and refer appropriate patient for
  evaluation and treatment. Administer or refer
  for immunization.
• A1C explained to patient
• BMI and/or Blood Pressure

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4. Drug Information Services to Patients

• Written or verbal patient-friendly and culturally
  competent drug information provided to consumers.
  
• Patient Drug Information leaflets
• Disease State Pamphlets

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5. Medication Reconciliation Services

• Identification of one accurate list of
  medications in combination with working directly
  with the patient or caregiver on their
  medications, recommendations and changes to
  therapy as appropriate, facilitation of
  communication of an accurate list of medications
  between patient, prescribers, and other health
  care professionals.
• Modified/updated current list
• Medication List given to patient
• OTC Meds included

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6. Provider Education

• Deliver evidence-based medical information to
  providers that focuses on the place in therapy
  and adverse effects associated with the
  medication.

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7. Retrospective Drug Utilization Review

• Periodic chart reviews in coordination with
  quality improvement for the purpose of evaluating
  organization performance in areas of medication
  prescribing and/or monitoring. Drug Utilization
  Reviews can be performed on patient profiles in
  dispensing and medical charts in primary care
  environments. Summary of evaluation is presented
  to clinical staff to support educational efforts,
  clinical program development as well as
  development of policies and procedures regarding
  medication use.
• DUR completed
• ADEs identified and remedied

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8. Medication Therapy Management

• Non-drug specific, non-disease specific and may
  include polypharmacy management, high risk / high
  alert medication management, and/or
  adherence/compliance education. MTM provider
  considers all medication related needs of the
  patient, not only those associated with a
  specific medical condition or therapeutic
  indication. May include utilization of
  collaborative practice agreements to create
  efficiency in patient management processes.
• Clinical Modifications made after DUR/ADE
• Recommendations given to patient or provider

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9. Disease State Management

• Provision of medication-related assessment and
  education within defined medical conditions or
  therapeutic indications (i.e. anticoagulation).
  May include utilization of collaborative practice
  agreements to create efficiency in patient
  management processes. May include group visits
  that focus on patient evaluation and/or
  disease-focused education.
• Medication modification to obtain goals
• Labs ordered

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10. Prospective Chart Review and Provider
Consultation

• Prospective review of a patients medical chart
  for the purpose of providing recommendations to
  the prescribing practitioner regarding medication
  adjustments on the day of a medical encounter.

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Pharmacist Role at Ocean Health
Initiatives

• Consult with providers and nurses
• Assist in medication therapy
• What medication to add to regimen
• Most cost effective therapy
• Side effects/drug-interactions

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How Clinical Pharmacy Benefits Patients

• Clinical Pharmacists are usually allotted more
  time to spend with the patients vs. their medical
  provider
• Increased Access to Care
• Better educated, more informed decision making
• Patient Centered Care
• Pharmacists are experts in medication safety
• Drug-drug interactions
• Drug-food interactions
• Drug-disease interactions

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How Clinical Pharmacists Benefit Health Center
Staff

• Provide up-to-date information
• New Guidelines
• New Medications
• News reports about medications
• Provide answers to patient questions before they
  are asked to medical staff

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How Clinical Pharmacists Benefit Health Center
Staff

• Chart review of difficult to manage patients
• Review patients not meeting goals
• Meets with provider and patient to improve
  patients understanding
• Spend more time educating patients/family
• Assists with chronic disease management

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Results of the PSPC

• Patient Centered Care
• Integrated Team Approach to Care
• Evidence Based Practice
• Improved Staff and Patient Morale
• Better Patient Outcomes

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Data Collection

• Demographics
• Age, gender, ethnicity
• Health Insurance
• Medicare, Medicaid, None
• Baseline Health Status and lab tests
• A1C, blood pressure, lipid levels, height,
  weight, BMI, co-morbid chronic conditions
• Follow up Health Status Markers
• CPS Visits
• ADEs/pADEs

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M.E.D.S Data

• September 2009

• April 2010

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M.E.D.S Data
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M.E.D.S Data
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Clinical Pharmacy Services
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Rate of pADEs and ADEs
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Clinical Pharmacy Services Most Utilized at OHI

• Medication Access Services
• Patient Counseling and Follow up Phone Calls
• Preventive Care Program
• Provider Education
• Disease State Management

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Accomplishments

• Obtained Hemoglobin A1C machine
• Prevents pADE/ADE
• Positive Reinforcement for Patients/Staff
• Medication Adjustments made in Real Time
• Improved Compliance
• Provided at low cost to uninsured patients
• Improved Patient Outcomes

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Accomplishments

• Weekly team meetings for case management
• Improved Patient Outcomes
• Patient/Staff Awareness
• Family Centered Care
• Community Partners for Patient/Staff Education
• Revising EMR template to capture CPS
• Administrative and BOD Support

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Case Presentation

• 52 year old male with h/o uncontrolled Diabetes
  and Hypertension began CPS 10/09. Services he
  received included
• CPS
• Nutritional Counseling
• Enrolled in Medicaid
• Medication Management
• Patient Education

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Challenges

• High number of patients are uninsured
• Many have more than one chronic medical condition
• Rise in medication cost and polypharmacy
• Providers are pressured to see more patients
  faster resulting in greater patient safety risk
  and lower patient satisfaction
• Maintain high quality of care within time
  restraints
• Data Collection
• Increase CPS
• Spread

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OHI M.E.D.S Team