e-Solutions July 2015
eSolutions: July 2015
Feature article: Pharmacists: An Untapped Resource in Integrated Care
Grantee Spotlight: Supporting Medication Management: Grand Lake Mental Health Center
Quick Tips: 5 Ways to Involve Pharmacists in Integrated Care
Featured resource: Essential Elements of Effective Integrated Primary Care and Behavioral Health Teams
As experts in medication, pharmacists’ skills and knowledge are a valuable resource for integrated care teams. While many primary and behavioral health clinics now have embedded pharmacies, the actual pharmacist is often an untapped resource.
Pharmacists are well positioned to support integrated primary care and behavioral health organizations — as part of the multidisciplinary team to support early identification of emerging health concerns, in offering supports to help ensure individuals take their medications safely and effectively and by offering mobile or in-home services to reduce barriers to access and lighten the workload for other members of the care team.
People are most familiar with a pharmacist dispensing medications, but pharmacists’ unique clinical experience allows them to do much more.
Pharmacists can serve the following roles within integrated care:
- Comprehensive medication management
- Medication reconciliation, which involves screening for drug interactions and improving transitions of care
- Preventive care services such as immunizations and screenings
- Patient education
- Collaborative care – participating as a member of the behavioral health/primary care team
Several programs that incorporate pharmacists in this way show positive outcomes in patients’ health.
For example, through the MyRx Medication Adherence Program, pharmacists paid home visits to seniors with diabetes and hypertension; the pharmacists offered culturally and linguistically tailored medication management, health education sessions and follow-up calls on care plans. As a result, program participants reduced their blood pressure, increased their understanding of diabetes and adhered better to medications.
At RiverStone Health Clinic, pharmacists delivered comprehensive medication management targeted to individuals with mental illnesses. For more than 150 patients, pharmacists reviewed all medications, and treatment plans, discussed any medication-related concerns, identified any problems with medication (from excessive or unnecessary prescriptions/doses to adverse reactions), and offered follow-up appointments to address these problems. RiverStone estimates this approach saves them over $90,000 and leads to improved clinical outcomes.
As part of the integrated care team, pharmacists can play a critical role in appropriate pain management and track medication-seeking behavior to prevent opioid addiction and overdose.
Getting the pharmacist out of the pharmacy
To fully support integrated care, relationships with pharmacists must move beyond the pharmacy.
Integrated primary care and behavioral health providers should incorporate pharmacists into the team however possible. Clinical pharmacists should attend treatment team meetings or huddles to discuss patient care and care plans, for the team to know about interactions of multiple medications and to discuss the potential side effects of medications the team should be aware of and relay to the individual. It is particularly important to involve a pharmacist as part of this team when an individual’s treatment includes multiple medications, the individual may be at risk for suicide or if someone shows signs of seeking medications beyond their treatment plan. Pharmacists can help providers to identify behaviors that may indicate a substance use concern (especially with opioid treatment).
When appropriate, patients can set up appointments with pharmacists to identify and resolve medication-related concerns or to address substance use.
A recent review of roles for pharmacists outlined how, increasingly, pharmacists support chronic disease management by sharing comprehensive medication information, promoting medication adherence and reinforcing healthy, prevention-based behaviors with patients.
Pharmacists can also lend their expertise to support primary care physicians in underserved areas and areas with professional shortages. At RiverStone, a community health center in Montana, where psychiatrists are scarce, psychiatric pharmacists consult with primary care physicians to support comprehensive medication management. Under a collaborative practice agreement, they provide interim visits to adjust dosages and screen for drug interactions. This approach not only allows pharmacists to tap into their full expertise, but also expands the psychiatrist’s availability in the community.
A whole team
Being part of the integrated care team allows pharmacists to see the full picture of care so they can help patients reach their health goals. As a tapped resource on your team, pharmacists can bring new expertise and support increased care quality.
Grand Lake Mental Health Center (GLMHC), a SAMHSA Primary and Behavioral Health Care Integration (PBHCI) grantee in northeastern Oklahoma, worked with an onsite pharmacy to incorporate pharmacists into the clinical team to enhance medication management and adherence.
Tracking Medication Adherence
Nine years ago, GLMHC recognized that they needed a better, more cost effective way to manage medications and eliminate waste and duplication across their nine locations. After contracting with a local pharmacy to establish an onsite pharmacy, GLMHC and the pharmacy worked together over several years to sync the clinic and pharmacy medical records to strengthen the flow of information to support medication management and adherence.
GLMHC and the pharmacy now have a comprehensive collaborative system in place called the Medication Adherence and Persistence Service (MAPS), which saves money and supports better health outcomes. MAPS measures the Medication Possession Rate (MPR) — the ratio used to track the amount of time a patient has access to a prescription. The pharmacy measures each patient’s medication, based on when the medication was filled — and when it was actually picked up. This accurate tracking mechanism prevents medications from being filled when a patient still has supply. MAPS also operates as an alert system that allows pharmacists to call patients five days before their medication is due to run out. If the patient does not pick up their prescription in time, the pharmacy alerts designated GLMHC staff. GLMHC staff then contacts the patient to determine what may be preventing them from accessing the pharmacy. Finally, GLMHC and the pharmacy connect to address any issues, decide if there is a need for additional patient education, a different medication or if a new treatment plan is necessary.
All of this information is shared through the two electronic health record systems and in a snapshot through a patient report card. This one page statement contains patient demographics, vitals and medication information. Providers review the report card before appointments and use it to guide talking points during the appointment, which allows providers to provide care that is tailored to the unique needs of the individual.
To measure the effect of MAPS, GLMHC and the pharmacy compared costs and the number of re-admissions prior to its implementation to outcomes five months after implementation. The data thus far demonstrates a cost savings of over $30,000 per month for GLMHC and a decrease in average monthly re-admissions by almost 12. GLMHC and the pharmacy continue to examine data from MAPS to inform transitions of care and track changes in hospital re-admissions.
A Part of the Team
Pharmacists are not confined to the pharmacy—they are members of the integrated care team. This close working relationship allows both organizations to stay abreast of updates and improvements. For GLMHC, incorporating pharmacists as a core part of the team ensures effective, efficient and quality care for the people they serve.
How does your organization work with pharmacists to support integrated care? Let us know, email Integration@theNationalCouncil.org.
How can pharmacists engage with your integrated care team? Here are some tips to help you get started.
- Learn what roles pharmacists are taking in collaborative care. Read some of the latest reviews of the profession, including the Value of Psychiatric Pharmacists as Part of the Healthcare Team, the Guidelines for Pharmacists Integrating Into Primary Care Teams and Exploring Pharmacists’ Role in a Changing Healthcare Environment.
- Educate your team members on the pharmacist’s role, particularly those providers who may not regularly interact with the pharmacist or pharmacy.
- Invite pharmacists to team huddles or meetings. If you work with a pharmacist that is offsite, discuss ways to set up regular communication.
- Discuss where the pharmacist(s) can contribute to the team and help expand workforce capacity, like supporting medication management, specific clinical decision support protocols and providing patient education.
- Encourage patients to ask pharmacists questions about their medications and to discuss any concerns with side effects, access or adherence to the treatment plan.
Check out CIHS’ team member webpage for further resources to help you build an effective team.
Essential Elements of Effective Integrated Primary Care and Behavioral Health Teams reviews effective team development strategies, identifies four essential elements for successful integrated care teams and provides a roadmap for organizations designing their own teams.
A roundup of the latest reports, grant opportunities and innovations related to integrated care.
HRSA announced $100 million to fund up to 310 health centers to improve and expand the delivery of substance abuse services, with a focus on medication assisted treatment (MAT) in opioid use disorders. Learn more about the opportunity, including an informational webinar on the funding on August 12 with the Bureau of Primary Health Care.
CDC’s new Vital Signs report discusses increased heroin use and ways health care providers can help curb the growing epidemic.
The Office of the Assistant Secretary for Health, in collaboration with HRSA, released Education and Training Resources on Multiple Chronic Conditions to educate health professionals on caring for people living with multiple chronic conditions.
The CDC’s Hypertension Control Change Package for Clinicians is an action guide from the Million Hearts initiative that provides tools to reduce hypertension.
SAMHSA’s Behavioral Health Equity Barometer provides a one-year snapshot of the state of behavioral health of youth and adults by demographics and insurance status.
Nearly half those who die by suicide are in contact with a primary care physician within one month of their death. Join this advanced practice webinar, The Primary Care Provider’s Role in Preventing Suicide, to learn how to move beyond the basics of suicide prevention toward real implementation strategies in primary care to improve systems of care to achieve zero suicides. Register here.
In case you missed it, access the recording of Improving Health through Trauma-Informed Care to learn how you can embed trauma-informed approaches into your practice.