EPIC a Chronic Disease Management Initiative in BC

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EPIC a Chronic Disease Management Initiative
in BC

• Barbara Ogle, BSc(Pharm), ACPR, MScPhm, RPh
• VP Clinical Services, Network Healthcare
• May 31, 2007

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Network Healthcare

• Network Healthcare
• A health services company that supports the
  development delivery of health care through
  sophisticated networks of clinical professionals.
  
• Pharmacist Network
• A service delivery arm of Network Healthcare that
  utilizes pharmacists to deliver care to patients.

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CURRENT HEALTH SYSTEM

• Health Care Organization
• Concern about the bottom line
• Incentives favor more frequent, shorter visits
• No organized QI

Community
Resources Policies No links to
community agencies or resources

• Self-Management Support
• Not systematic
• Didactic

• ClinicalInformationSystems
• Dont know patient or their needs

• System
• Design
• Reliance on short, unplanned visits

• Decision
• Support
• No agreement on good care
• Traditional referrals

Uninformed, Passive Patient/ Caregivers
Frustrating Problem-Centered Interactions
Unprepared Practice Team
Sub-optimal Functional and Clinical Outcomes
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Chronic Disease Management in British Columbia

• gt 50 of BC health care budget goes to the 10 of
  people with chronic diseases
• Ministry of Healths response
• Adopted the Expanded Chronic Care Model and
  Patient Self-Management
• Used Primary Health Care Transition Funds for
  strategic initiatives focused on high-risk,
  high-cost CDM patients

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Expanded Chronic Care Model
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EPICEmpowering Patients through Integrative
Care
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Business Need

• Expand the primary care team where gaps exist
  (pharmacist)
• Increase system capacity to meet periodic needs
  of patients for more intense support
• Increase access to timely support between
  appointments and where rural or individual
  barriers to service exist

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Goal

• To develop and evaluate the feasibility of a
  telehealth model for pharmacists to provide
  self-management and medication management support
  to people with diabetes or heart failure in
  collaboration with primary healthcare teams.

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Objectives

• Increase patient self-efficacy and
  self-management with medications
• Improve attainment of desired drug therapy
  outcomes
• Improve medication safety

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Pharmacist Intervention

• Community pharmacist as virtual member of health
  team
• Provide telehealth coaching, information and
  self-management support for up to 6 weeks
• Identify, prevent and/or manage potential and
  actual drug-related problems
• Provide clinical decision support to the family
  physician and primary healthcare team
• Facilitate transition to community resources
  (e.g., community pharmacist, local groups)

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Project Details

• Timeline
• Planning 2004
• Pilot Testing 2005
• Data Collection 2005 2006
• Team
• BC Ministry of Health
• BC NurseLine
• Pharmacist Network BC
• University of Victoria Centre on Aging
• Fraser Health Authority
• Northern Health Authority

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Patient Findings (n 201)

• Learned self-management skills
• Resolved drug-related problems
• Became more engaged in their own care
• Improved health status
• Liked having telehealth in their own home,
  interpreters and flexible times
• Regular follow-up kept patients focused

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Physician Findings (n 112)

• Collaborative interactions observed
• Electronic lab data accessed for some
• Telehealth was economical, scalable, and
  sustainable
• Follow-up extended beyond practice
• Focus on patient self-management filled existing
  care gap

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Other Research

• Impact of medication therapy discontinuation on
  mortality after MI
• Endpoints use of aspirin, ß blockers and statins
  at 1 month mortality _at_ 12 months
• gt33 had stopped one or more medications
• 12.1 had stopped all three
• Poorer 1-year survival than those persisting
  88.5 vs 97.7, plt0.001
• Risk factors include age and education

PM Ho et al. Arch Intern Med 20061661842-1847.
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Other Research
Other Research

• Drug-related hospitalizations in a tertiary care
  internal medicine service
• n565 adult patients admitted to hospital
• Drug-related 24.1 (95 CI 20.6-27.8)
• Adverse drug reactions 35.3
• Improper drug selection 17.6
• Noncompliance 16.2
• Majority of cases were preventable
• 72.1 (95 CI 63.7-79.4)

Samoy LJ et al. Pharmacotherapy 2006261578-86.
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Other Research

• Effectiveness of telephone counselling by a
  pharmacist in reducing mortality in patients
  receiving polypharmacy
• RCT, n502 non-compliant pts
• 6-8 telephone calls between visits
• Polypharmacy 5 or more medications
• Endpoint all-cause mortality in 2 years
• ARR 6 (17 control vs 11 intervention)
• RRR 41 (95 CI 0.35-0.97, p0.039)
• NNT to prevent 1 death 16

JYF Wu. BMJ  2006333522, doi10.1136/bmj.38905.
447118.2F
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Compared to

• Statin therapy
• Based on 2003 Canadian guidelines
• NNT to prevent 1 death due to CHD over 5 years
  for high risk Canadians is 98
• Canadian statin market 1.4B

10-year risk of CHD 20, or history of CVD or
diabetes with age gt 30 yrs
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Going Forward

• BC
• Alberta
• Service Development
• SAFERx (real world safety effectiveness)
• Seamless Medication Care
• Chronic Disease Management (medication management
  and self-management support)
• Medication Reviews and Assessments
• Emergency Preparedness

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The Innovation Challenge
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Contact Information

• Barbara Gobis Ogle,
• Vice President, Clinical Services
• Network Healthcare
• bogle_at_networkhealthcare.ca
• 604-231-3245