Clinical Pharmacy Services: How ADAP Clients Can Benefit !

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Clinical Pharmacy Services How ADAP Clients
Can Benefit !

• Zandra M. Glenn, PharmD
• HRSA- Pharmacy Services Support Center
• July 10, 2008

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What are Clinical Pharmacy Services?

• That area of pharmacy concerned with the science
  and practice of rational medication use.
  American College of Clinical Pharmacy
• Clinical pharmacy is more oriented to the
  analysis of population needs with regards to
  medicines, ways of administration, patterns of
  use and drug effects on the patients. The focus
  of attention moves from the drug to the single
  patient or population receiving drugs. European
  Society of Clinical Pharmacy
• Patient-centered services that promote the
  appropriate selection and utilization of
  medications. Its objective is to optimize
  individual therapeutic outcomes. HRSA - PSPC

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Traditional vs. Clinical Pharmacy

• Traditional Pharmacy Services
• Synthesis and chemistry of medication
• Preparation of drugs
• Dispensing medication services
• PRODUCT focus

• Clinical Pharmacy Services
• Individualized medication monitoring and
  evaluation
• Patient-centered care
• Integrated health care team in which pharmacist
  is directly involved in patient care
• PATIENT focus

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Mathematica Report

• Objective (in response to the 2007 Senate
  Appropriations Committee Report) To provide
  recommendations on how to generate improvements
  in the use of clinical pharmacy services across
  all HRSA programs (including ADAP programs) in
  which medication plays an integral role in
  patient care.
• Reports will be used for HRSA to draft
  recommendations/report to Congress.

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Case Study Sites
Community Health Centers (CHC) Comm. Health Assoc. of Spokane - WA Comm. Health Centers Inc.- UT El Rio Health Center - AZ Miles Square Health Center - IL Partnership Comm. Health Center- MT Siouxland Comm. Health Center - IA Westside Comm. Health Center - MN
Disproportionate Share Hospitals (DSH) Boston Medical Center MA Grady Health System GA Harris County Hospital TX Huey Long Hospital LA Parkland Hospital TX Shands Hospital FL (2 sites)
AIDS Drug Assistance Programs (ADAP) FL ADAP (Bond CHC) GA ADAP (Grady Health System) MN ADAP (Westside Clinic) SC ADAP (Central Fill Pharmacy) Washington DC ADAP (Whitman-Walker)
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Variations in Clinical Services
Interactions with Patients One-on-one patient appointments Walk in consultations Group visits Chart reviews
Interactions with Medical Providers Mix of Collaborative Practice Agreements/Protocols/Referrals Patient visits with physicians
Patient Services Provided Medication reconciliation/Change in drug therapy Adherence Programs Refill reminders Pharmacist Specialty Clinics (Primary care, Diabetes, Asthma, Lipid, Anticoagulation, Allergy, Geriatrics, Oncology, HIV, etc.)
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Variations in Clinical Services
Range of Pharmacist Responsibilities Wide range in patient volume (5-80 patients/week) Formulary Management Involvement in health disparities collaboratives Traditional dispensing duties
Other Variations Wide range in pharmacist training Salary variations
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Reasons for Initiation of Clinical Pharmacy
Services

• Opportunity for quality improvement with complex
  patients
• Grant programs (Federal and State)
• Push by pharmacy champion
• Cost Containment
• high volume, high risk, high cost patients
• Formulary Management
• Cost of Indigent Patients
• Pharmacist Interest
• Physician Demand

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Barriers to Clinical Pharmacy Services

• Funding / Lack of reimbursement
• Space
• Turf issues
• Physician Acceptance / Lack of awareness of
  pharmacists abilities
• Pharmacist recruitment and retention
• Language barriers
• Lack of documentation / tracking to prove impact
  of clinical services
• Patients lack of awareness of pharmacists
  abilities

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Financing

• Grants (State programs, Ryan White funds, etc.)
• Administration allocating funds from other
  departments
• Limited Billing
• Medicaid
• Medicare billing (Part B and Part D)
• Colleges of Pharmacy
• Full or partial salary for faculty
• Fees to precept students / rotation sites

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Benefits of Clinical Pharmacy Services

• Improved outcomes
• Reduced costs
• Improved patient access
• Improved efficiency of medical providers
• Improved quality of prescribing
• Patient satisfaction
• Improved patient knowledge

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An Unique Model

• FL ADAP initiated Clinical Pharmacy Services
• Collaboration between
• FL ADAP Program
• Partial funding
• Florida AM University College of Pharmacy
• Traditional pharmacy services
• Pharmacy resident
• Partial funding
• FQHC
• Primary care services for ADAP clients
• County Health Department
• Facility

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Role of Pharmacy Resident

• ADAP pharmacist
• Work closely with ADAP coordinator
• Evaluate labs every 3 months
• Review and dispense medication regimens
• Identify medication management interventions
• Monitor prescription adherence
• Consult and educate patients (one-on-one patient
  visits every 6 months)
• Consult, educate, and interact with physicians,
  and support staff (meet with providers weekly)

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Pharmacists Interventions

• Identified Therapeutic Duplication 5
• Additional Drug Needed 20
• Incorrect Therapeutic Dose 20
• Patient Education 25
• Identified Adverse Reactions 30

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Next Steps

• Make a commitment to provide clinical pharmacy
  services
• Seek out collaborating partners
• Think outside of the box
• Establish programs to document and track outcomes
  from clinical programs
• Contact PSSC for help

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PSSC Pharmacy Services Support CenterThe 340B
Access Resource

• Established through a contract between APhA and
  HRSA
• Established 2002
• Renewed 2007
• Enhances Office of Pharmacy Affairs (OPA)
  resources to optimize the value of the 340B
  program in order to provide affordable,
  comprehensive pharmacy services that improve
  medication use and advance patient care and
  patient access to affordable drugs.

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Pharmacy Services Support Center

• Information management
• Organizing pharmacy expertise and resources
• Responding to 340B inquiries
• Policy analysis
• Monitoring pertinent policy developments
• Communication and education on policy issues and
  Medicare
• Networking
• Communication and education
• Presentations
• Project development

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PSSC PharmTA

• Free technical assistance for 340B-eligible
  entities interested in setting up or enhancing
  clinically and cost effective pharmacy services
• PharmTA consists of a pool of pharmacy experts
  who work one-on-one with entities through phone
  and/or on-site consultations to maximize 340B at
  individual entities
• For more information 1-800-628-6297 or visit
  http//pssc.aphanet.org/

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Contact Information

• Zandra Glenn, PharmD
• rzglenn_at_comcast.net
• 1-800-628-6297
• http//pssc.aphanet.org/