The idea that good health care can best be delivered if a patient has a medical home first emerged in the field of pediatrics more than 40 years ago. It was offered as a tool to address the needs of children with special health needs. In the current health care reform debate, the medical home concept has reemerged as a key component in a restructured health care system. The medical home does not just focus on a disease or body part, but on the whole patient and the patient’s environment, so health care is more effective and costs are less.
Many medical homes do not currently use a pharmacist. Is this because pharmacists’ skills do not contribute to improved quality and reduced cost? Or has pharmacy done a poor job of promoting our role?
Recent communication with a pharmacist, Sarah McBane, PharmD, who works in a Medical Home Team at Duke Family Medicine, suggests that pharmacists, in fact, do make a valuable contribution. Her team provides care to 13,000 patients. Her story is an important one. Dr. McBane explains: “I work conjunctly with other providers to improve care of many different chronic conditions, including diabetes, hypertension, tobacco abuse, and asthma. I see patients on a scheduled basis and also serve as an on-call medication specialty consultant to our providers.
“Many of the patients I work with have been diagnosed with type 2 diabetes. Diabetes affects nearly all components of a patient’s life—there are new medications to take, new blood tests needed, changes in diet and activity, and often changes in self-perception. This is often too much for one person to manage at one time, so it is important to assess the patient’s interests and personal goals. I always review and assess a patient’s medication therapy, but my time is more often focused on finding out what is important to the patient. My goals for each encounter are to improve both health status and quality of life, but meeting the patient’s goal is key to achieving my goals.
“How does this fit into the medical home picture? Care of chronic illness has many facets and is often too complex for a single busy provider to manage. Many chronic conditions rely on medications for symptom control and reduction in mortality. A pharmacist works closely with the primary provider to ensure that safe and effective use of medications. Pharmacists monitor for drug interactions and side effects, ensure necessary laboratory monitoring is performed, and evaluate effectiveness of medication regimens. Pharmacists also talk with the patient and find out the patient’s viewpoint on the medications.”
Dr. McBane has clearly established the role of the pharmacist in the medical home, demonstrating that pharmacists do contribute to improved quality and reduced cost of care. If we want the pharmacist’s role in the medical home included in the reformed health care system, we must do a much better job of telling our story. That is up to each of us.