Community pharmacists develop DM network
July 1, 1998 3 minutes read
Community pharmacists develop DM network
Program gets right patients on right drugs
When 10 independent community pharmacists in the eastern part of Iowa decided to test the disease management waters, they knew they would drown if they tried to do it alone. So three years ago, they created the Certified Pharmaceutical Care Network, which first provided support and a network of ideas and later evolved into a quality assurance network that presents a common voice when dealing with third-party payers and employers.
"Most people tend to think of pharmacy more as a product," says Randy McDonough, MS, RPh, assistant professor in the college of pharmacy at the University of Iowa in Iowa City. "We're still providing the product, but now we're also making sure the patients are meeting the goals of the drug therapy. We're making sure patients are informed about their therapy and how it's affecting them, and we're showing them how they can also be an active member of the health care team."
One of the network's first efforts, an ACE inhibitor project, has met with early success. In the first two months of the project, 30% of the 142 diabetes patients evaluated were identified as possible candidates for ACE inhibitors. The pharmacists checked to see whether diabetes patients had received a microalbuminuria test, which determines whether protein is spilling into the urine. The test is recommended in the American Diabetes Association guidelines, and a positive result means ACE inhibitors could help the patient, McDonough says. The patients were referred to a local diabetes center, which contacted their physicians with the suggestion that they do the test and evaluate the potential benefit of prescribing an ACE inhibitor.
The network also has been participating in a two-year demonstration project with Blue Cross/Blue Shield to determine how pharmacists can improve the bottom line of health care. The project focused on ischemic heart disease, diabetes, asthma, and hypertension. The data are still being collected on that project, McDonough says, but the key to ensuring economic and clinical success is developing standards of practice and ensuring compliance with those standards.
"We wanted to make sure our network was at a level that we could guarantee the quality, so we developed a report card," says McDonough, who serves as clinical pharmacy specialist to the network. "We can't expect other health care providers to buy in to our program if we can't prove what a difference we can make." He visits the pharmacy sites weekly to ensure the pharmacists are meeting the minimal standards set by the network, including documentation of patient information, formulation of a written plan of care, collection and assessment of outcomes data, and ongoing monitoring.
Within those standards, the network has developed educational programs focusing on different disease states, including diabetes, asthma, and hypertension. Programs for osteoporosis, hormone replacement therapy, and migraine are in the works. For each disease, the pharmacists provide patient education using materials developed by the network. The most popular tool has been a flip chart that provides visuals for the patient on one side and notes for the pharmacist on the back. The pharmacists have monthly meetings during which they work on their clinical skills, McDonough says.
The asthma program, for example, consists of a needs assessment, three educational sessions, documentation, and a patient satisfaction survey. The sessions are set up as follows:
1. Baseline measures, patient history form, overview of asthma and its triggers, and instruction on keeping the patient symptom log.
2. Review of patient's symptom log including any exacerbations or hospitalizations, review of patient's medications, development of a care plan, and instruction on medications used for the treatment of asthma.
3. Instruction on peak flow monitoring, care plan review, and patient satisfaction survey.
After the three scheduled sessions, the patient is monitored for three months and then given the chance to enroll in an ongoing pharmaceutical care program.
"I've been very impressed with what the pharmacists have been able to achieve," McDonough says. "But it works because we emphasize a team approach. We fit within a system and report back to the physician.We're not an island."
The network has developed a benefit package that is being marketed to employers, health care brokers, and third-party payers this summer, McDonough says. The pharmacists want to show employers that by paying for appropriate drug therapy, especially for asthma and diabetes patients, they can cut down on absenteeism and increase productivity.
[For more information on pharmacist networks, contact Randy McDonough, MS, RPh, assistant professor, 5513 College of Pharmacy, University of Iowa, Iowa City, IA 52242. Telephone: (319) 335-8623.]
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