Role of Clinical Pharmacists in Disease State Management Amy - PowerPoint PPT Presentation


PPT – Role of Clinical Pharmacists in Disease State Management Amy PowerPoint presentation | free to view - id: 3af419-YmQwN


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation

Role of Clinical Pharmacists in Disease State Management Amy


Role of Clinical Pharmacists in Disease State Management Amy M. Lugo, PharmD, BCPS, CDM Clinical Coordinator Clinical Specialist, Internal Medicine – PowerPoint PPT presentation

Number of Views:2201
Avg rating:3.0/5.0
Slides: 46
Provided by: wwwnehcM


Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Role of Clinical Pharmacists in Disease State Management Amy

Role of Clinical Pharmacists in Disease State
  • Amy M. Lugo, PharmD, BCPS, CDM
  • Clinical Coordinator
  • Clinical Specialist, Internal Medicine
  • Department of Pharmacy
  • National Naval Medical Center
  • Bethesda, Maryland

  • Review the BUMED requirement for disease state
  • Describe how pharmacists can assist in your
    disease management programs
  • Define the roles and responsibilities of a
    clinical pharmacist
  • Provide evidence supporting the use of
    pharmacists in disease management programs
  • Discuss the credentialing process for clinical
    pharmacists and provide a sample collaborative
    practice agreement

(No Transcript)
(No Transcript)
BUMED Requirement
  • Navy Medicine (NAVMED) Policy 06-011
  • Disease Management Programs
  • Asthma
  • Diabetes
  • Breast Health
  • Dental Health
  • MedIG Checklist

Disease State Management
  • A continuous, coordinated, evolutionary process
    that seeks to manage and improve the health
    status of a carefully defined patient population
    over the entire course of a disease
  • A successful DSM program achieves this goal by
    identifying and delivering the most effective and
    efficient combination of available resources
  • Encompasses the entire spectrum of health care
  • Includes prevention efforts as well as patient
    management after the disease has developed

Academy of Managed Care Pharmacy
Collaborative Drug Therapy Management (CDTM)
Collaborative Drug Therapy Management (CDTM)
  • A collaborative practice agreement between one
    or more physicians and pharmacists wherein
    qualified pharmacists working within the context
    of a defined protocol are permitted to assume
    professional responsibility for certain tasks

Pharmacotherapy 2003231210-1225.
Collaborative Drug Therapy Management (CDTM)
  • Tasks include
  • Performing patient assessments
  • Ordering and evaluating drug therapy-related
  • Selecting, initiating, monitoring, continuing and
    adjusting drug regimens
  • Assessing patient response to therapy
  • Counseling and educating a patient on medications
  • Administering medications

Pharmacotherapy 2003231210-1225.
Collaborative Practice
  • Collaborative Drug Therapy Management (CDTM)
  • 43 states have some form of CDTM or collaborative
  • Authority is generally incorporated in the state
    pharmacy practice act
  • Describes the authorized scope of practice

Pharmacists in the Navy
  • Licensed Independent Practitioners (LIP)
  • BUMEDINST 6320.66E
  • BUMEDINST 6320.66D
  • No requirement for collaborative practice
  • No requirement for notes and orders to be
    co-signed by physicians
  • Scope of practice determined by individual

Components of a Collaborative Practice Agreement
  • A pharmacist agrees to work with prescriber(s)
    under a written, signed agreement
  • Agree to perform certain patient care functions
    under specified conditions
  • The pharmacist must possess the knowledge, skills
    and ability to perform the authorized functions
  • Determination of competence is usually left up to
    the individuals who are party to the agreement

Components of a Collaborative Practice Agreement
  • Authority to document activities in a medical
  • Accountability for the same quality measures for
    all those involved in the collaborative agreement
  • Provisions to allow compensation for drug therapy
    management activities

Roles and Responsibilities of a Clinical
  • Assuring safe, accurate, rational and
    cost-effective use of medications
  • Engage in collaborative practice with other
    healthcare practitioners for the purpose of
    improving care and conserving resources
  • Make patient-focused transitions into and out of
    acute care practice settings, ambulatory care or
    alternative site settings with the patients best
    interest in mind
  • Possess in-depth knowledge of medications that is
    integrated with a foundational understanding of
    the biomedical, pharmaceutical, sociobehavioral,
    and clinical sciences

American College of Clinical Pharmacy
Roles and Responsibilities of a Clinical
  • To achieve desired therapeutic goals, the
    clinical pharmacist applies evidence-based
    therapeutic guidelines, evolving sciences,
    emerging technologies, and relevant legal,
    ethical, social, cultural, economic and
    professional principles
  • Assume responsibility and accountability for
    managing medication therapy in direct patient
    care settings, whether practicing independently
    or in consultation/collaboration with other
    health care professionals
  • Within the system of health care, clinical
    pharmacists are experts in the therapeutic use of
  • Routinely provide medication therapy evaluations
    and recommendations to patients and health care

American College of Clinical Pharmacy
Other roles
  • Clinical pharmacist researchers generate,
    disseminate, and apply new knowledge that
    contributes to improved health and quality of life

American College of Clinical Pharmacy
The Process
  • Pharmacists find a physician
  • Physicians find a pharmacist
  • Discuss the role the pharmacist will play
  • Each commands credentialing committee determines
    pharmacists scope of practice
  • Not necessary, but strongly encouraged to have
    collaborative practice agreements with providers

Medication Management Services
  • Identify a need
  • Build support for services
  • Determine the focus of the service
  • Develop patient care protocols
  • Market the service
  • Receive additional training if needed
  • Provide care and document outcomes

Pharmacotherapy 2003231153-1166.
Identify a Need
  • Focus group discussions
  • Networking with opinion leaders
  • Surveys of physicians within a practice
  • Identify high risk patients
  • Identify costly disease states

Pharmacotherapy 2003231153-1166. Pharmacy Times
Build Support for Services
  • Identify practice champions
  • Build relationships with key people such as
    nurses, billing specialists, and lab personnel
  • Market what you can do for patients

Pharmacotherapy 2003231153-1166. Pharmacy Times
Determine the Focus of the Service
  • Use needs assessment data to decide what services
    will be offered
  • Determine how you can enhance what services are
    already being provided
  • Other Considerations
  • Your patient population
  • Pharmacy staff expertise
  • BUMED requirement and MedIG checklist

Pharmacotherapy 2003231153-1166. Pharmacy Times
Develop Patient Care Protocols
  • Develop practice-specific standards for care
  • Network with colleagues
  • Base protocols on national standards
  • Sample Protocol

Pharmacotherapy 2003231153-1166. Pharmacy Times
Market the Service
  • Market to physicians, clinic champions and
  • Share the benefits of the service 11 and at
    staff meetings
  • Marketing ideas include flyers, posters, and

Pharmacotherapy 2003231153-1166. Pharmacy Times
Receive Additional Training
  • Council on Credentialing published definitions of
    credentialing in 2001
  • Opportunities include additional education
    through residencies, traineeships, certificate
    programs, and CE
  • Certification examinations include BPS, CGP,
    disease management, and various multidisciplinary

Council on Credentialing. AJHP 20015869-76
Pharmacists CredentialsCertifications
  • Pharmacists need to demonstrate that they possess
    the knowledge to manage certain disease states
  • Board of Pharmaceutical Specialties
  • Diabetes
  • Certified Diabetes Educator (CDE)
  • Certified Disease Manager (CDM)
  • Asthma
  • Certified Asthma Educator (AE-C)

Pharmacists CredentialsCertificates
  • Certificate Programs
  • State associations
  • Colleges of pharmacy
  • Regional AHECs
  • National associations
  • National meetings (APhA)
  • Pharmacy-Based Immunization Delivery
  • Pharmaceutical Care for Patients with Diabetes
  • Pharmacy-Based Lipid Management
  • OTC Advisor Pharmacy-Based Self-Care Services
  • Delivery Medication Therapy Management Services
    in Your Community

Provide Care and Document Outcomes
  • Provide pharmaceutical care
  • Document the visit appropriately for the level of
    service provided
  • Evaluate humanistic, financial and therapeutic

Pharmacotherapy 2003231153-1166. Pharmacy Times
Supporting Evidence
  • American Pharmacists Association
  • Listed by disease state
  • Referenced primary literature
Supporting Evidence
  • Precedents
  • Veterans Health Administration
  • VHA Directive 2003-004
  • Department of the Army
  • AR 40-68, Chapter 7, Subparagraph 8
  • North Carolina
  • 21 NCAC 46.3101 Clinical Pharmacist Practitioner
  • Maryland
  • 12-6A-01 12-6A-10 Drug Therapy Management

The Asheville Project
  • 1997 2007
  • 2 self-insured employers
  • Many spin-off projects
  • gt 900 patients
  • Diabetes
  • Asthma
  • Hyperlipidemia
  • Hypertension
  • Depression pilot study

J Am Pharm Assoc. 20034317384.
The Asheville Project
  • Patients have co-pays waived
  • Patients must see their pharmacist at least
  • Pharmacists are paid for their time
  • Results
  • ? total health care costs per pt per yr
  • ? work productivity

J Am Pharm Assoc. 20034317384.
The Asheville ProjectDiabetes 5 Year Results
  • N 187
  • Mean A1c ? at all follow-ups, with more than 50
    of patients demonstrating improvements at each
  • The number of patients with optimal A1c values
    (lt 7 ) also ? at each follow-up
  • gt 50 showed improvements in lipid levels at
    every measurement
  • Patients with higher baseline A1c values or
    higher baseline costs were most likely to improve
    or have lower costs, respectively

J Am Pharm Assoc. 20034317384.
The Asheville ProjectDiabetes 5 Year Results
  • Costs shifted from inpatient and outpatient
    physician services to Rxs, which ? significantly
    at every follow-up
  • Total mean direct medical costs ? by 1,200 to
    1,872 per patient per year compared with
  • Days of sick time ? every year (19972001) for
    one employer group
  • Estimated increases in productivity estimated at
    18,000 annually

J Am Pharm Assoc. 20034317384.
The Asheville ProjectAsthma Data
  • Asthma program implemented in 1999
  • 2 self-insured employers
  • N 207
  • Outcome measures
  • FEV1
  • Asthma severity
  • Symptom frequency
  • Presence of an asthma action plan
  • Asthma-related emergency department/hospital
  • Changes in asthma-related costs over time

J Am Pharm Assoc. 200646133147.
The Asheville ProjectAsthma Results
  • All measures of asthma control improved and were
    sustained for as long as 5 years
  • FEV1 and severity classification improved
  • Asthma action plans ? from 63 to 99
  • ED visits ? from 9.9 to 1.3
  • Hospitalizations ? from 4.0 to 1.9
  • Spending on asthma medications increased

J Am Pharm Assoc. 200646133147.
The Asheville ProjectAsthma Results
  • Asthma-related medical claims ? and total
    asthma-related costs were significantly lower
    than the projections
  • Direct cost savings averaged 725/patient/year
  • Indirect cost savings were estimated to be
  • Missed/nonproductive workdays ? from 10.8
    days/year to 2.6 days/year
  • Patients were 6 times less likely to have an
    ED/hospitalization event after program

J Am Pharm Assoc. 200646133147.
Keys to Success in Replicatingthe Asheville Model
  • Focus on the patient and desired outcomes
  • Include all stakeholders in planning and
  • Maintain open communication, sharing information
    in a timely fashion
  • Ensure that the role of each team member is clear
  • Health care team members should be supporting
    each othernot duplicating efforts
  • Respect, integrity, trust, and excellence of each
  • Coordination of patient referrals
  • Education of patients and providers
  • Aligned incentives for seeking and providing care

Pharmacy Times June 2005.
Clinic Reengineering
  • Carved out or carved in
  • Pharmacotherapy clinic vs. diabetes clinic
  • Obtain AHLTA training and become familiar with
    clinic operations
  • Continuously educate physicians and support staff
    about pharmacy services
  • Actively seek referrals to fill clinic spots

Credentialing Process
  • Required Documents
  • BUMEDINST 6320.66E - Core privileges
  • BUMEDINST 6320.66D - Supplemental privileges
  • Optional Documents
  • Peer review evaluation form
  • Performance Assessment Review (PARs)
  • Protocol/Collaborative practice agreement
  • Clinical specialist position description
  • Supporting evidence

Additional Supporting Evidence
  • Clinical Pharmacy Services associated with
    decreased mortality rates
  • Pharmacist-provided drug use evaluation (4491
    reduced deaths p0.016)
  • Pharmacist-provided in-service education (10,660
    reduced deaths, p0.037)
  • Pharmacist-provided ADR management (14,518
    reduced deaths, p0.012)
  • Pharmacist-provided drug protocol management
    (18,401 reduced deaths, p0.017)

Pharmacotherapy 200727(4)481493.
Additional Supporting Evidence
  • Clinical Pharmacy Services associated with
    decreased mortality rates
  • Pharmacist participation on the CPR team
    (12,880 reduced deaths, p0.009)
  • Pharmacist participation on medical rounds
    (11,093 reduced deaths, p0.021)
  • Pharmacist-provided admission drug histories
    (3988 reduced deaths, p0.001)

Pharmacotherapy 200727(4)481493.
(No Transcript)
Billing Incident To Physician Services
  • An option for pharmacists practicing in a
    physicians office
  • Not an option for pharmacists who provide
    services in a community pharmacy
  • Allows physicians to bill for services provided
    by non-physicians
  • Specific criteria for use

Billing Incident To Physician Services
  • Criteria for use
  • The service must be an integral, although
    incidental, part of the physicians professional
  • commonly furnished in physicians office
  • Provided under direct supervision of a physician
  • Provider must be a contractural worker
  • Evidence has shown that pharmacists involvement
    in disease management improves outcomes
  • Pharmacists are uniquely positioned to play a
    role in disease state management
  • We can help commands meet BUMED requirements
  • Publishing and presenting our successes will
    support future endeavors