By Melinda Young
Some health systems are trying to integrate pharmacists in primary care units in hopes of improving outcomes for patients with chronic diseases, such as diabetes and hypertension.
One model is to assign four or five primary care providers per pharmacist and create a co-visit model that integrates pharmacists in care involving medication management, says Nabeel Qureshi, MPH, an assistant policy researcher at the RAND Corporation.
A recent study by Qureshi and colleagues revealed that implementing ambulatory care pharmacy programs requires integrated workflows, established revenue streams or addition of indirect value, leadership advocacy, and coordination among stakeholders. Continued improvement also is important to sustain a program.1
Disease Management
General pharmacists can help with disease management by providing counseling to patients. They also can provide guidance to providers on new medications and how these may interact with patients’ drug regimens.
“They can bring in a pharmacist to do more specific medication-based issues, the more complex cases,” Qureshi says. “It’s not specific to a specialty, but specific to medication.”
The typical model is for the pharmacist to introduce the patient in a warm handoff between the physician and pharmacist. The physician lets the pharmacist know of their intention in initiating or changing medication, and the pharmacist handles the education part, saving the physician time during the patient visit.
“Then, the pharmacist provides a final summary, and the physician reviews it,” Qureshi explains.
The hospital can employ pharmacists to help primary care practices, working with a cluster of providers.
Case manager nurses, care coordinators, or others involved in a hospitalized patient’s care team can make sure patients schedule an appointment with a primary care provider. Then, patients are referred to a pharmacist. This model works for a large health system in California.
“There’s leadership support around integration, and there is work going on in the pharmacy side to see outcomes and drivers of costs within the program,” Qureshi adds. “We look at outcomes, and we’ve heard from pharmacists and physicians that it streamlines the process.”
Other benefits include:
- Ensuring patients are taking their medications properly;
- Patients better understand their treatment and medications.
Program Challenges
Setting up a program that includes a pharmacist in primary care can be challenging. “You have to change the minds of physicians who have been doing things for years one way and have to do this additional referral,” Qureshi explains. “But once they work through that, physicians have been largely supportive.”
The program is voluntary. Physicians may use the referral for some patients and not for others. There is some variation on when they may refer a patient to the pharmacist.
“We find that most physicians are using it to some degree, and there are very few holdout physicians who are not using pharmacists,” Qureshi says.
For example, a physician may ask for help from the pharmacist if a patient needs a new diabetes management medication. The most common conditions driving referrals to a pharmacist are diabetes and hypertension, Qureshi says. For patients who are discharged with new or different medications, a physician may ask for help in determining how to incorporate or change the discharge medication regimen.
“The primary care provider may be the first person to decide what they want to do with hospital medication information, but if it’s complex, they may refer to the pharmacist,” Qureshi says.
The main goal of involving a pharmacist is to prevent readmissions and to reduce the use of inappropriate medications for patients who take five or more drugs.
“The goal is to improve outcomes,” Qureshi says.
REFERENCE
- Qureshi N, Keller MS. Identifying implementation factors for the development, operation, and sustainment of ambulatory care. J Gen Intern Med 2023; Aug 24. doi: 10.1007/s11606-023-08375-1. [Online ahead of print].
Some health systems are trying to integrate pharmacists in primary care units in hopes of improving outcomes for patients with chronic diseases, such as diabetes and hypertension. One model is to assign four or five primary care providers per pharmacist and create a co-visit model that integrates pharmacists in care involving medication management.
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