Pharmacists Ally with Physicians in Caring for Patients

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Mr. Lamb is a freelance pharmacy writer living in Virginia Beach, Va, and president of Thorough Cursor Inc.

If anyone is qualified to comment on what theAsheville Project is as it completes its 10th year, it isJ. Paul Martin, who was a key physician member ofthe multidisciplinary group that established theprogram.

When asked to give a one-sentence description, he saidthat the Asheville Project ?is about how the pharmacist isable to be an ally with the physician in improving adherencewith medications and compliance with all the otheraspects of the entire care regimen.?

Martin was and is the medical director of health servicesfor the City of Asheville and the medical director for staffhealth services at Mission St. Joseph?s Hospital, the 2 self-insuredemployers that are the principal underwriters of theAsheville Project. In both positions, Martin identifiespatients who could benefit from having pharmacistsbecome more involved in their care and refers those individualsfor enrollment in the program. Beneficiaries have apharmacist regularly monitor their condition, review theirmedications, and develop a treatment plan in conjunctionwith them and their physician. Over time, the pharmacistmay make recommendations for therapeutic changes.

?It?s a phenomenal resource for everybody,? Martinsaid. ?As a referring physician, I know that this programwill help patients get the care they need. The primaryphysician is freed up to spend time on resolving problems,and the patient can develop a personal relationship withtheir pharmacist. It?s a win?win for everybody.?A Decade of Growth and Service

Since 1997, enrollment has grown steadily, mirroringthe expansion of diseases for which patients can receiveeducation, free medications and supplies, and counselingand lifestyle-change coaching. Patients with diabetes, asthma,depression, hypertension, and hypercholesterolemianow have access to pharmacist-coordinatedcare.

?We started with diabetes because it wasan obvious need among our beneficiaries; itwas also a disease where it is very easy forpharmacists to make a huge difference bygetting patients to be more compliant withtheir medications and testing,? Martin said.?But, we certainly felt that we had a conceptthat could be duplicated in other settingsand with other conditions. And that?s whatwe?ve seen as we?ve added other conditions.The first-year results from the depressionproject are very positive.?

Other chronic health problems are alsobeing targeted, such as asthma, hypertension, depression, obesity, and arthritis. ?Arthritis causes asmuch 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 [preventionof] drug interactions can make a huge difference.?Open, Ongoing Communication

That the model is adaptable and effective was confirmedwhen 5 employers in different states implemented it andsaw diabetic employees experience ?significant improvementin clinical indicators of diabetes management, higherrates of self-management goal setting and achievement, andincreased satisfaction with diabetes care.?1

Two keys to making those programs work, according toMartin, are ensuring that physicians understand and supportthe pharmacist?s role, and establishing and maintaininggood communication.2 Martin noted that when theAsheville Project was launched, ?there was initially somemisunderstanding among physicians that maybe the pharmacistswanted to be in full control of the patient and prescribing.Once they understood the pharmacist was moreof a cheerleader, a coach, and an advocate for the patient,they embraced it. Now, physicians love having theirpatients in the program and are pleased because they areseeing better outcomes and are actually seeing theirpatients more frequently than before their involvementwith the pharmacist coach.?

On communications, Martin explained, ?The challengefor pharmacists is finding the best way to share informationwith physicians. Some like to get faxes; others likephone calls; others prefer e-mails. Once that is worked out,the back and forth between physicians and pharmacistsgoes pretty smoothly.?