Asheville Spinoff Sets Sights on Asthma and Heart Disease
LivingMyLife, a Pittsburgh-based diabetes management program modeled after the Asheville Project, recently announced it will extend pharmacist coaching to patients with asthma and heart disease. Organized by the Pittsburgh Business Group on Health (PBGH), the experimental program is part of the Diabetes Ten City Challenge, a national research initiative to investigate the benefits of collaborative diabetes care.
Counseling from pharmacists has been a central component of LivingMyLife since it began in 2006, when 24 of PBGH’s 60 member organizations agreed to provide ongoing disease management counseling, medications, and testing supplies to its employees with diabetes. PBGH partnered with the American Pharmacists Association (APhA) and Duquesne University School of Pharmacy to provide diabetes education training and certification to a network of participating pharmacists.
Today, more than 200 patients take advantage of LivingMyLife’s one-on-one counseling services, which are provided in 80 local chain and independent pharmacies. Although researchers have yet to complete their analysis of the program’s cost benefits, it has yielded measurable improvements in self-management behaviors—a goal PBGH outlined at its annual symposium on health care in September.
Presenting to attendees, executive director Christine Whipple explained: “The common thread is, how can employers engage people in how they use their benefits and how they manage their heath?” As illustrated by projects in Asheville, Pittsburgh, and other areas of the country, coaching from pharmacists is fast becoming a determining factor in the equation.
According to an APhA report, patients who participated in LivingMyLife achieved better blood pressure and blood sugar control. They were also more likely to receive annual eye and foot exams. These simple preventive steps could substantially limit costs, keeping patients out of the hospital and in control of their condition.
The expansion is expected to occur in early 2011. By offering coaching for heart disease and asthma in addition to diabetes, Whipple and her colleagues hope to spread the message of patient engagement to a broader population and increase support for those struggling with chronic illnesses. In doing so, she said, “we know we would be touching children all the way up to retirees.”
Pharmacists’ Impact Dependent on Fair Payment, Access to Records
Pharmacists should function “at the top of their training,” wrote B. Joseph Guglielmo, PharmD, in a recent article published by the Archives of Internal Medicine. In order for community pharmacists to transition into that role, however, certain barriers must be addressed—namely, the current reimbursement model and pharmacists’ access to medical records.
The article was written in response to the “disappointing results” of a recent study, which found that continuing education training did not improve pharmacists’ ability to counsel patients for smoking cessation. Through his analysis of the results, Dr. Guglielmo brought many concerns that have historically plagued pharmacists into a very broad and public spotlight.
He noted that the pharmacists in the study did not have access to patients’ medical records, nor were they reimbursed for the services they provided. Like many retail pharmacists, their interaction with other health care providers was limited.
Calling pharmacies “isolated,” Dr. Guglielmo called for improved communication between pharmacists and other health care providers. He imagines a future in which community pharmacists occupy a role similar to that of hospital pharmacists, whose interventions have proven instrumental in reducing medication errors and improving treatment outcomes.
Dr. Guglielmo also addressed the economic obstacles that prevent some pharmacists from adopting a counseling role. Echoing a battle cry of overworked retail and community pharmacists, he criticized the existing pharmacy reimbursement model for its emphasis on prescription quotas, rather than counseling. “An economic model that is solely driven by prescriptions filled per day will not unleash the full potential of these well-trained, but clinically underused professionals,” he wrote.
One potential solution could be to assign pharmacists provider status through Medicare, which would include a fee schedule for practitioner service. A handful of states have designated pharmacists as providers of medication therapy management, but this has not been sufficient to expand the pharmacist’s role nationwide.
If community pharmacists are to make a direct impact on patient outcomes, Dr. Guglielmo said, the current system must change—and quickly. As an additional 32 million individuals gain coverage under the new health care reform law and the number of providers grows scarcer, pharmacists’ services are urgently needed.
“Improved availability of medical records, integrating pharmacists into the health care team, and changes in the reimbursement model would stimulate community pharmacists to ‘function at the top of their training’ while improving access to health care,” he stated.
Pharmacist Care Yields Economic and Therapeutic Benefits
Collaborative care that involves pharmacists reliably improves treatment and may help minimize health care costs, according to a new systematic research review. In an analysis of nearly 300 studies, pharmacists reduced the rate and severity of adverse drug events, improved indicators of chronic disease, lowered hospitalization costs, and increased patients’ sense of well-being with regard to their health.
The results were revealed in 2 separate literature reviews, both led by Marie A. Chisholm-Burns, PharmD, MPH, FASHP, professor and head of the Department of Pharmacy Practice and Science at the University of Arizona College of Pharmacy in Tuscon. Both were profiled in the October issue of the journal Pharmacy Practice News.
Dr. Chisholm-Burns hopes the results will further the case for pharmacists as part of the health care team—not just among pharmacists and health care professionals, but also patients. “I know we’ll talk about it within pharmacy, but I want patients to know,” she said. “I want my grandmother to know that if she goes into the hospital, she should ask to talk to a pharmacist. When consumers start asking for our services, it will show the need and the niche for our role.”
The first review, which was originally published in the journal Medicare Care, examined the therapeutic, safety, and humanistic results achieved when pharmacists work closely with physicians and nurses. Pharmacist-provided care yielded favorable results across the board. The most common positive therapeutic outcomes were measurements for blood pressure, low-density lipoprotein cholesterol, and hemoglobin A1C , which improved in 84.7%, 81.5%, and 88.9% of studies, respectively.
Among those studies that focused on safety outcomes, 60% showed a reduction in adverse drug events and 81.8% showed a reduction in medication errors. When pharmacists were enlisted in direct patient care roles, risk of adverse drug events was cut by 47%. Patients whose pharmacists worked closely with them were also more likely to adhere to their medications, thoroughly understand their condition, and report greater satisfaction with their care.
The second review was less conclusive, but suggests that pharmacists could lower medical costs for individual patients, employer groups, and health care providers. Researchers discovered a range of economic benefits that included lower copayments for patients, reduced hospital charges for readmissions, and fewer sick days. The results of the economic analysis were published in the American Journal of Health-Systems Pharmacy.