| 1 | 1 stop! collaborate and listen: using practice agreements in ambulatory care jenna carmichael,...

Download | 1 | 1 STOP! Collaborate and Listen: Using Practice Agreements in Ambulatory Care Jenna Carmichael, PharmD, BCOP Hematology/Oncology MTM Pharmacist Geisinger

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| 3 | 3 Objectives 1.Discuss utilizing a collaborative practice agreement in providing new services 2.Review challenges and potential solutions in this new setting | 3

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| 1 | 1 STOP! Collaborate and Listen: Using Practice Agreements in Ambulatory Care Jenna Carmichael, PharmD, BCOP Hematology/Oncology MTM Pharmacist Geisinger Health System, Henry Cancer Center Wilkes-Barre, PA Disclosures Advisory board member, Boehringer Ingelheim This is not a presentation on setting up collaborative practice agreements | 2 | 3 | 3 Objectives 1.Discuss utilizing a collaborative practice agreement in providing new services 2.Review challenges and potential solutions in this new setting | 3 | 4 Pretest Question You have started a new clinic providing MTM services in an ambulatory setting. All of the providers in the clinic with the exception of one are very excited to have you a part of the team. How do you approach the outlier? a)Ignore them, you will have more than enough to do as is b)Try to discuss potential patients with this providers nurse c)Bring in food to entice the provider to like you d)Make yourself visible to the clinic staff and offer help when needed e)A, B and D | 5 Background Medication Therapy Disease-State Management (MTDM) started at Geisinger Medical Center in pharmacists Anticoagulation only | 6 Background Currently there are 52 pharmacists working in 47 locations Anticoagulation Diabetes Hyperlipidemia Hypertension Polypharmacy Anemia Nonmalignant chronic pain Heart failure Multiple sclerosis Hematology/Oncology 2 new clinics scheduled to open in next few months | 7 Collaborative Practice Pharmacists work in tandem with physicians under collaborative practice to treat patients for specific disease states Need to show competency in each disease state Initial and then yearly exam Professional certifications encouraged | 8 Collaborative Practice Under the agreement, pharmacists are able to: Order labs/tests Modify current medications Add on new medications Patients are managed over the phone or in person Reimbursement from insurance is only for in person visits | 9 STARTING NEW SERVICES | 10 First Things First Decide what to focus your services on Collaborative practice agreement will guide you However, plan for the future and make this as broad as possible Start with the service you feel is needed most or easiest to start Every patient that comes into the clinic with BP > 160/90 Use the EMR and find every patient on DM drugs that doesnt have labs in the last year Ask your collaborating physicians what they want you to focus on first | 11 First Things First Decide how you want your clinic to function A lot of this depends on the building set up Is there room to see patients How far do your patients have to travel if they were to come in Can some of this feasibly be done over the phone If the patient needs labs, is there a lab closer to them and you can call with results What role is your clinic playing Drug/lab monitoring Warfarin, tacrolimus, Hgb for erythropoietin, lipids for statins Disease state management Hypertension, diabetes | 12 Addressing Roadblocks Unfortunately, some providers will not be as willing to work with you as others Dont push You will likely have a lot of work to do without their patients Work on establishing your services and your reputation among other providers Eventually your good work will speak for itself! | 13 Tips for Success Make yourself visible If you are not doing anything, walk around the clinic You may overhear a problem that you can help with! Use the physician-nurse relationship to your advantage Find out what the nurse does that you could help with I hear Mr. Peters called with a side effect from his metformin, do you want me to call him back for you? Have a direct phone line Takes call volume off front desk Patients like having a way to get to someone directly But then can get calls that are not entirely your scope | 14 Tips for Success Ask questions If your provider is doing something a bit off guidelines Tactfully ask why If a new practitioner or new to this type of practice, use that to your advantage and ask in the spirit of education Explain your process to your providers You know what you are doing, but they may not Particularly helpful when first starting new services Ask the provider their process and compare with yours Everyone has their favorite go to medication for certain disease states Everyone likes to feel involved | 15 Tips for Success Be Available for Questions Answer everything Renal dose adjustments, preferred agent to treat XXX infection, etc. Be prepared for off the wall questions Be Nice Kill them with kindness Treat everyone from the front desk staff up with respect Everyone has bad days, dont take it out on anyone If someone is nasty to you, shake it off! | 16 Tips for Success Know when to ask for help If there are other clinics in your system, help each other out Try to resolve issues with staff on your own but also know when to bring in supervisors/management | 17 Building Additional Services Once you establish yourself as a medication expert, your providers will ask you to take on more patients/disease states You did such a good job getting Mrs. Jones A1c to goal, why dont you also help with her heart failure? Thank you so much for catching Mr. Smiths drug interaction, hes feeling much better. Can you look at Mrs. Roberts medications too? Dont try to take on so much that you cannot consistently provide quality care Remember, taking care of patients is your top priority | 18 Posttest Question You have started a new clinic providing MTM services in an ambulatory setting. All of the providers in the clinic with the exception of one are very excited to have you a part of the team. How do you approach the outlier? a)Ignore them, you will have more than enough to do as is b)Try to discuss potential patients with this providers nurse c)Bring in food to entice the provider to like you d)Make yourself visible to the clinic staff and offer help when needed e)A, B and D | 19 QUESTIONS/COMMENTS? | 20