Gary Matzke - VCU Health Sciences

Report
Innovations in Interprofessional
Practice 2013
Gary R. Matzke, Pharm.D, FCP. FCCP, FASN, FNAP
School of Pharmacy
Virginia Commonwealth University
Learning Objectives
• Identify key events that have shaped
interprofessional education and practice
transformation.
• Describe the interprofessional care models in
which academic pharmacists have practiced in
Virginia.
• Characterize the "Improving Health of At risk
Rural Patients" interprofessional care model
Activities at the State Level
• Gov. McDonnell establish a Healthcare Reform
Advisory Council
• What issues are important to Virginians?
• It has been a very active process
• Advisory Committee made up of 30 people, 6
subcommittees
• Medicaid, Workforce, Insurance costs,
Telemedicine
• Report: Dec 2010 -- 28 recommendations on how
Virginia should move forward
• www.HHR.virginia.gov
Pharmacy Practice Transformation
at the State Level
• The Virginia Pharmacy Congress reviewed the
December 2010 report of the Virginia Health Reform
Initiative Advisory Council
• Collectively the Congress supported the statement from
that report suggesting “changing scope of practice
laws to permit more health professionals to practice
up to the evidence-based limit of their training”.
• The Congress crafted a policy position document that
addressed the value that pharmacists can bring to direct
patient care and identified the barriers to integration of
pharmacists in interprofessional practices and thus the
broad provision of these clinical services in Virginia.
Pharmacy Practice Transformation
Following an initial diagnosis, pharmacists can deliver
a number of patient care services in a variety of
practice settings through collaborative practice
agreements with other healthcare providers
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Perform or obtain necessary assessment of the health and functional status
of each patient;
Initiate, modify or discontinue treatment to manage disease according
to therapeutic goals agreed upon by the primary provider and the
patient;
Order, interpret and monitor laboratory tests;
Formulate clinical assessments and develop therapeutic plans;
Document and communicate essential information about the care delivered
to other appropriate health care providers;
Provide education and training to the patient or caregiver designed to
enhance understanding and appropriate use of medications and adherence
with treatment regimens;
Provide care coordination and services for wellness and disease prevention.
2011 U.S. Surgeon General’s Recommendations
Pharmacists Interprofessional Care
in the Community
• Models: Service, Education, Scholarship
• Goals: Enhance Medication Access, Safety,
and Outcomes
• Roles: Patient, Provider, Learner Education
• Coordinated Care within “system”
• Engaged with Community Partners
• Interprofessional
IHARP Project
Improving Health of At-Risk Rural Patients
Key Principals
Michael J. Czar RPh, PhD – Project Coordinator
William T. Lee RPh, MS – Principal Investigator
Anthony R. Stavola MD– Co-Principal Investigator
Gary R. Matzke Pharm.D. – Co-Principal Investigator
Leticia R. Moczygemba Pharm.D., PhD – Co-Investigator
Charles Tarasidis RPh – Director, Carilion Retail Pharmacy Operations
Chad Alvarez RPh – Director, Pharmacy TSG/Epic Initiative
Karen J. Williams Pharm.D. – Lead Primary Care Clinical Pharmacist
Heidi Wengerd Pharm.D.- Primary Care Clinical Pharmacist
Health Care Needs of Community
Reasons for Hospitalizations
Planning District
Heart Disease
Cerebrovascular
Disease
COPD
Diabetes
Asthma
State of Virginia
98.1
26.9
17.8
15.1
11.8
Alleghany
108.9
31.9
21.5
17.4
10.2
Central Shenandoah
104.9
25.4
18.2
25.8
9.0
Central Virginia
Cumberland
Plateau
Mount Rogers
101.9
31.9
25.4
22.1
15.1
114.4
20.8
78.8
18.7
21.5
69.7
17.8
21.8
14.8
6.9
New River
138.2
29.2
30.0
17.1
10.3
Roanoke City
West Piedmont
125.1
102.7
31.2
26.9
30.8
29.3
33.5
26.7
18.7
12.2
The number of hospitalizations is the age-adjusted rate per 10,000 people.
statistically significant difference
Source: Chronic Disease Indicators by Health District 2010.
Improving Health of At Risk Rural Patients
• Create a sustainable patient centered continuity of care
process within a rural health system comprised of multiple
hospitals, primary care practices, and community
pharmacies;
• Achieve better health outcomes for patients by
establishing a coordinated “community-based,”
individualized prevention and wellness strategy
• Reduce costs by optimizing medication-related health
outcomes of hospitalized and ambulatory patients;
• Implement two new models of pharmacist workforce
development and training; and
• Evaluate the clinical, humanistic and economic outcomes
associated with this new health care delivery model
Carilion Clinic Characteristics
Service Area
Resources, etc. (FY 2011)
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Headquartered in Roanoke, Va.,
Carilion Clinic serves the residents
of 18 counties and six cities in
western Virginia and southern
West Virginia.
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Primary Service Area (PSA):
653,717
Secondary Service Area: 334,379
Community Benefit
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Uncompensated Care: $106.7 million
Education: $20.4 million
Research: $ .7 million
Total: $131.1 million
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Employed physicians: 575
representing more than 60
specialties
Practice sites: 160
Primary care visits: 767,283
Employees: 10,975
Licensed beds: 1,187 (does not
include 60 Neonatal ICU beds
available)
Admissions: 49,074
Emergency Department visits:
179,664
Total revenues: $1.28 billion (net)
The Role Of Pharmacists in
the “Medical Home”
• Pharmacists should play key roles as team
members in medical homes,
• Their potential to serve effectively in this role
should be evaluated as part of medical home
demonstration projects.
• 71 percent of physician office visits had at least
one prescription listed in the patient record.
• 32 percent of adverse events leading to hospital
admission were attributed to medications
• 33–50 percent of patients with chronic conditions
adhere completely to prescribed medication
therapies
Interprofessional Practice is Crucial
to our Future
• Team members work closely together,
• They collaborate and communicate frequently,
establish team goals, and support each other’s
contributions, while each shares his or her own
knowledge and skill set,
• Team members are involved in problem solving
beyond the confines of their own disciplines; they
are partners in designing a plan of care; they have
joint responsibility for action,
• The team capitalizes on its diversity and executes its
work in a flexible and synergistic manner.
A Team must have a Common
Game Plan or Strategy
• True teamwork depends on the mutual exchange
of sufficient patient information and a sharing of
decision-making, so that the team can function
as an efficient, coordinated unit to the benefit of
the patient.
• Teams succeed when each member is willing to
look past their needs and contribute to the
common good of in this case THE PATIENT
• Pharmacists in community settings have long
been hampered in their goal of providing direct
patient care because they have had insufficient
patient medical information
Key Elements for Successful Practice
• Can’t be a provider of care if you don’t know where the
patient is clinically! It starts there, not with the medications
• Must know the clinical status of the patient related to
each and every condition that is being prevented or
treated by drug therapy (or should be treated by drug
therapy)
• Can’t assess the adequacy of the meds if you don’t know
the stage of the disease
• The days of pen and paper records are over- robust IT and
clinical pathways required
• Must be capable of recognizing and making evidencedbased recommendations to resolve drug therapy problems
to obtain clinical goals of therapy
Institutional Component
PHARMACY
ADMISSION NOTE
PHARMACY CONSULT
NOTES/Interventions
Pharmacy Discharge
Note / Summary of
Medication Issues
Recommendations for MD,
Patient, PCCP, & CP
Patient
Community
Pharmacists
Non Carilion
Practices
Community Component
Patient follow up post DC & ongoing
Primary Care
Pharmacist
Medication
Management Care Plan
Provide ongoing care
as part of health care
team.
Carilion
PCMH
Primary Care Component
IHARP Impact Map
Community Pharmacies & Providers
CMM
Medication Reconciliation
Medication Adherence
ADE Monitoring
Monitoring Drug Therapy
Outcomes
Disease State Education
and Management
Carilion
PHYSICIANS
PATIENT
Drug Information for
Physicians and
Providers
Up-to-Date
Medication List
Coordination
of Care
Carilion
PROVIDERS
Monitor and Clarify
Incomplete
Prescribed Drug Orders
Public Health of Southwest Virginia
• We utilized a three tiered approach to enhance the
practice skills of our pharmacists
• The ADAPT process developed by the Canadian
Pharmacists Association was the foundational initiative
for our hospital and primary care pharmacists
• The VCU MTM training program was the mechanism
through which we integrated community pharmacists
• Finally the Carilion IT staff developed an EPIC training
program for community pharmacists
Collaboration
It’s about team work, and
partnership building will
get you there.
Phase One Rollout 2013
IHARP
RX
IHARP
RX
IHARP
RX
IM-Christiansburg
FM- Radford
FM & OB-Christiansburg
St.
Alban’s /
CNRV
FM-Floyd
FM-Shawsville
FMNorth Main
FM-Blacksburg
IHARP
RX
FM-Pearisburg
IHARP
RX
IHARP
RX
CGCH
Tazewell
FM-Narrows
IHARP
RX
Health Outcomes Evaluation
• Clinical, economic, and humanistic outcomes will be
evaluated quarterly.
• Disease specific clinical measure outcomes will be assessed
from baseline to last visit.
• Patient satisfaction and physician, nursing staff, and
pharmacist perceptions of IHARP will be evaluated quarterly
• The economic analysis will ascertain the impact of this
intervention strategy on participants overall healthcare costs
by:
• comparing their health care utilization in the year prior to participation
with the utilization during the final year of the project.
• Comparing the costs of a matched comparison group selected
retrospectively from those monitored in the same time frame.
Implementation Challenges
• Establishing a community expectation for pharmacist’s
delivered clinical services
• Development of consistent practice deliverables
• Improving Health Information Technology
• Future innovations in funding
• Student and practitioner education and training
Future Directions
• Engage other communities within Virginia in
health care system reform to increase access,
improve quality, and reduce the cost of health care.
• Disseminate the results of the project broadly in
peer –reviewed journals and via non-traditional
means such as community presentations to
business and corporate leaders, government
agency officials, and health care consumer
organizations.
• Partner with others across the country to assess
the value of implementing similar care models in
other populations.
Interprofessional Practice is
OUR FUTURE
DISCUSSION

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