bringing mtm to the patient - home - calrightmeds
TRANSCRIPT
Pilot Pharmacy Project at QueensCare Health Centers
CECILIA WU, PHARMDCLINICAL PHARMACIST
Bringing MTM to the Patient
Learning Objectives
Describe the goals of the BD Helping Build Health Communities™ grant.
Explain the rationale for the pilot pharmacy project and discuss the alignment with CRMC goals.
Develop a strategy for restructuring pharmacy workflow to improve diabetes medication use and monitoring.
The Grant – BD Helping Build Healthy Communities™
Program Goals – to expand access to care, improve healthcare in underserved communities Donations for medical supplies Grants for CHC’s with innovative models of care
Since 2013 – 36 health centers - awards for diabetes, HIV/AIDS, cervical cancer screening
2017, focus on innovative MTM (Medication Therapy Management)
The Idea…
Clinical Pharmacists can NOT see every uncontrolled DM pt
Many Patients NO SHOW to clinic appts, labs, etc.
But patients make it to the pharmacy regularly
A great opportunity for MTM (education, management)
Clinical Pharmacistsin health centers
Mission
Reduce the burden of chronic disease by advancing the role of pharmacists in the healthcare system
Vision
Establish a network of pharmacies in the community that provide high-impact Comprehensive Medication Management (CMM) services that is sustainable and aligned with population health priorities within health plans and health systems, as well as serve as access points for health and social services.
MTM Project Implementationfocus on the process…
Who are our patients?
What do they need? Which disease state(s) to focus on?
What are our strengths? What are our limitations?
What can we do to help our patients? What easy steps can we start with?
Background info
FQHC – 5 health centers in Los Angeles, 2 pharmacies
2018 - 24,162 unique pts 28% Pediatric 60% Adult (18-64 yrs) 12% Elderly (>65 yrs)
60% Non-English speaking Largest group Hispanic/Latino origin (70%)
78% Below Poverty Level
4,287 Diabetic patients (2018) ~1/4 have A1c > 9% or no lab in past year East LA health center worst DM control
Limited/fixed access –schedule 8-12 pt/day
In-depth interactionsLonger (15-30min) encountersSpecialist in chronic disease
Residency trainingCollaborative Practice
agreementFull chart access
Open access – no appts
Superficial interactionsShort encounters
Basic disease knowledgeUsually no residency
trainingNo Collaborative Practice
agreementLimited chart access
Clinical Pharmacists
In-house Pharmacy
Clinical Pharmacists
In-house Pharmacy
• Patient Rapport• Speak Language• More accessible
than PCP• Free access to
Pharmacist• One health
system
Simple Targeted MTM Interventions
Trigger Assessment Intervention
Rx Type, Fill, Check Pt pickup
MedicationA1c lab
1-3 questions by Tech
Consultation by RPh based on
pt response
Triggers for MTM – casting a wide net
Any Diabetes TESTING supply Rx (Glucometer, Test Strips, Lancets) proper glucometer, lancet use review SMBG goals
Any INSULIN Rx being picked up counsel on adherence tips
Will Call Pts with Overdue A1c (>4 mo.s) lab same day
Will Call Pts with Elevated A1c (>/=10%) discuss with patient
Sample Patient Interaction
Diabetic Patient comes to Pharmacy to pick up meds (ex: Test Strips)
Pharm Tech asks Patient:
-Problems using meter?-Know BG goals?-Know what to do if BG too
high/low?
Pharmacy Staff can provide education:
-Glucometer & Lancet Use-Review BG Goals-Review Hypoglycemia
management-Refer Patient back to PCP, or
Clinical Pharmacist, Nutritionist, etc
How do we target uncontrolled Diabetics? Need clinical data
Pharmacy software & EHR software do NOT communicate
Manual chart review - Too time-consuming to check EHR for each DM prescription
Quick access list of data - A1c moving target (changes every few months)
Process can NOT slow down Pharmacy operations
Will Call IT program cross references Will Call report with EHR data
Med bags are flagged for intervention
Triggers for MTM - focused approach
Any Diabetes TESTING supply Rx (Glucometer, Test Strips, Lancets) proper glucometer, lancet use review SMBG goals
Any INSULIN Rx being picked up counsel on adherence tips
Will Call Pts with Overdue A1c (>4 mo.s) lab same day
Will Call Pts with Elevated A1c (>/=10%) discuss with patient
A1c Data
# Patients Average A1c
Baseline (w/in 6 mo.s of 1st intervention)
427 9.32%
1st f/u A1c 349 8.97%
2nd f/u A1c 217 8.73%
3rd f/u A1c 85 8.35%
Number of Patients Served
Patient MTM Encounters 1077
Unique DM Patients 441
Distribution of A1c’s
56
126107
83
BaselineN = 427
57
135103
54
1st f/u A1cN = 349
36
99
53
29
2nd f/u A1cN = 217
14
48
15
8
3rd f/u A1cN = 85
< 7%
7 – 8.9%
9 – 11%
> 11%
Our Next Steps
Roll out in HW Pharmacy busier, more diverse (serves HW, EP, ER)
Add more clinical interventions at ELA pharmacy recommendations for therapy changes review glucometer readings
Target more Care Gaps (HEDIS measures) Eye Exams Podiatry
Challenges
Staff Training
Pharmacy staff were “shy” (not accustomed to talking to pts clinically)
Patient acceptance
Streamlining data collection, errors in data entry
Linking pharmacy operation to clinical data
Reproducible at 2nd pharmacy site?
Sustainability & funding sources
Things to think about…
Who are your patients?
What do they need?
What are your strengths? What are yourlimitations?
What can you do to help your patients? What easy steps can you start with?
In-House PharmaciesHollywood East 3rd
Daily Rx #Average 333 Rxs(range 315-351)
Average 174 Rxs(range 166-185)
Staff1.2 RPh2 Tech
1 Assistant
1 RPh1-2 Tech
Patient Population
Hispanic, Armenian/Russian
KoreanHispanic
otheriPad
KL-60 RobotiPad
Consultation Room