If anyone is qualified to comment on what the Asheville Project is as it completes its 10th year, it is J. Paul Martin, who was a key physician member of the multidisciplinary group that established the program.
When asked to give a one-sentence description, he said that the Asheville Project ?is about how the pharmacist is able to be an ally with the physician in improving adherence with medications and compliance with all the other aspects of the entire care regimen.?
Martin was and is the medical director of health services for the City of Asheville and the medical director for staff health services at Mission St. Joseph?s Hospital, the 2 self-insured employers that are the principal underwriters of the Asheville Project. In both positions, Martin identifies patients who could benefit from having pharmacists become more involved in their care and refers those individuals for enrollment in the program. Beneficiaries have a pharmacist regularly monitor their condition, review their medications, and develop a treatment plan in conjunction with them and their physician. Over time, the pharmacist may make recommendations for therapeutic changes.
?It?s a phenomenal resource for everybody,? Martin said. ?As a referring physician, I know that this program will help patients get the care they need. The primary physician is freed up to spend time on resolving problems, and the patient can develop a personal relationship with their pharmacist. It?s a win?win for everybody.?
Since 1997, enrollment has grown steadily, mirroring the expansion of diseases for which patients can receive education, free medications and supplies, and counseling and lifestyle-change coaching. Patients with diabetes, asthma, depression, hypertension, and hypercholesterolemia now have access to pharmacist-coordinated care.
?We started with diabetes because it was an obvious need among our beneficiaries; it was also a disease where it is very easy for pharmacists to make a huge difference by getting patients to be more compliant with their medications and testing,? Martin said. ?But, we certainly felt that we had a concept that could be duplicated in other settings and with other conditions. And that?s what we?ve seen as we?ve added other conditions. The first-year results from the depression project are very positive.?
Other chronic health problems are also being targeted, such as asthma, hypertension, depression, obesity, and arthritis. ?Arthritis causes as much disability in older patients as diabetes, high blood pressure, and asthma combined. It?s also a disease in which pharmacists? interventions to ensure pain treatment and [prevention of] drug interactions can make a huge difference.?
That the model is adaptable and effective was confirmed when 5 employers in different states implemented it and saw diabetic employees experience ?significant improvement in clinical indicators of diabetes management, higher rates of self-management goal setting and achievement, and increased satisfaction with diabetes care.?1
Two keys to making those programs work, according to Martin, are ensuring that physicians understand and support the pharmacist?s role, and establishing and maintaining good communication.2 Martin noted that when the Asheville Project was launched, ?there was initially some misunderstanding among physicians that maybe the pharmacists wanted to be in full control of the patient and prescribing. Once they understood the pharmacist was more of a cheerleader, a coach, and an advocate for the patient, they embraced it. Now, physicians love having their patients in the program and are pleased because they are seeing better outcomes and are actually seeing their patients more frequently than before their involvement with the pharmacist coach.?
On communications, Martin explained, ?The challenge for pharmacists is finding the best way to share information with physicians. Some like to get faxes; others like phone calls; others prefer e-mails. Once that is worked out, the back and forth between physicians and pharmacists goes pretty smoothly.?
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