2013 Wisconsin Health Improvement and Research Partnerships Forum

12 September 2013

Union South, University of Wisconsin - Madison

Betty A. Chewning, PhD., FAPhA

David H. Kreling, RPh, PhD

David Hahn, MD, MS

PEARL Rx and WREN Partnership: Parallel Surveys To Explore Potential Inter-Professional

Collaboration

• focus on quality of care and outcomes• increasing time pressures on clinicians• increased complexity and medications in a central role• increased emphasis on inter-professional collaboration

The current environment for outpatient care includes:

Consequently, physicians and pharmacists are likely partners for increasingly working together, especially around patient medication management.

This survey is a product of the collaboration between the WREN team and the PEARL team and respondents.

AcknowledgementsLois Sater (PEARL RX)Erin Leege (WREN)Roberta Carrier, RPh

Objective:

To survey members of the Wisconsin Research Education Network (WREN) and the Pharmacy Practice Enhancement Action Research Link RX (PEARL Rx) to assess possibilities for inter-professional collaboration around patient medication management.

Methods: Design: Parallel surveys for physicians and pharmacistsSamples: WREN and PEARL RX research network membersAdministration: Email contacts; Qualtrics online survey platform Survey: 1. Perceptions about a set of patient-care pharmacist activities

MDs: already have RPhs do, would like RPh to do, not interestedRPhs: already provide, would like to provide, not interested

2. Frequency of direct interaction about patient careMD → RPh and RPh → MD

3. Preferred method of communicatingMD – “most preferred method”RPh – “what method works best”

4. Interest in working on a joint project5. Percent of patients for whom they get up-to-date medication

lists after transition home from hospitalization or NH care

Response Summary

PEARL RX (RPhs): A total of 41 usable responses from 59 contacted (69.5%)

WREN (MDs): 83 MDs (out of ~300 contacted) accessed the survey;

Usable data for 63 respondents (21%);

Clinician Type: MD: 54, DO: 2, PA: 3, NP: 3, not stated:1

WREN Survey member: 43 yes (68%), 3 no (5%), 16 not sure (27%)

Dane 12La Crosse 9Manitowoc 3Milwaukee 3(1) Brown, Dodge, Dunn, Grant, Green, Jackson, Rock,Shawano, WalworthWashington, WaupacaWinnebago

Dane 12Milwaukee 10Monroe 5Juneau 5Outgamie 3(2) Barron, Dodge, Fond du Lac,Rock, Sheboygan, Waukesha,Wood(1) Chippewa, Dunn, Eau Claire,Grant, Kenosha, MarinetteRichland, Sauk, TrempeleauWinnebago

PEARL RX - RPhWREN - MD

Response Summary – Geographic Dispersion (by County)

Med Reco

ncil

Device

Ed

Monitor P

t Stat

us

Med Afford

Assist

DailyDose

Orchest

r

Optimiz Tx D

ecns

Pt Med

Chk-Up

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

WREN (MDs)

Yes Would Like Not Interested

Med Reco

ncil

Device

Ed

Monitor P

t Stat

us

Med Afford

Assist

DailyDose

Orchest

r

Optimiz Tx D

ecns

Pt Med

Chk-Up

0%10%20%30%40%50%60%70%80%90%

PEARL RX (RPhs)

Yes Would Like Not Interested

Perceptions about Pharmacist Services

MD RPh0%

5%

10%

15%

20%

25%

30%

35%

40%

Pharmacist Contact Physician

Daily Weekly Monthly Annually Never

WREN (MD): how often contact you about patient care issues beyond RX order information? PEARL RX (RPh): not including to obtain RX orders, how often interact about care for their patients?

MD RPh0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Physician Contact Pharmacist

Daily Weekly Monthly Annually Never

WREN (MD): how often interact for input and experience relevant to patients you care for?PEARL RX (RPh): other than to provide RX info, how often contact you about their patients?

FAX Phone Email Shared Elec Face/In person0%

10%

20%

30%

40%

50%

60%

70%

80%

MD RPh

Preferred Method for Communicating

WREN (MD): most preferred method for communicating with pharmacistsPEARL RX (RPh): What methods work best for you to communicate (check all)

Yes No Possibly0%

10%

20%

30%

40%

50%

60%

70%

80%

MD RPh

Would you be interested at some point in working with physicians/pharmacists in your region on a joint project?

Interest in a Joint Project?

0% <= 20% 21 - 40% 41 - 60% 61 - 80% 81 - 99% 100%0%

5%

10%

15%

20%

25%

30%

35%

40%

MD RPh

Up-to-date Medication Lists after Transition Home from Hospital or NH Care

For about what percent of your patients do you get up-to-date medication lists following a transition home from hospitalization or nursing home care?

Conclusions

• Considerable interest was present from both groups for many of the pharmacist services.

• Pharmacists more often reported daily or weekly interactions about patient care issues – around half for both directions of contact.

• ‘Traditional’ means of communicating (phone and FAX) remain common; shared electronic records also used by ~25+% of both groups.

• A high proportion of both groups expressed interest in potentially working on a joint project.

Implications – Moving Forward

• Interest in the services and in potentially working on a joint project suggests doors may be open for enhanced collaboration. However, for some, the extent of interaction was low - an area for development and growth.

• Next steps?• Begin exploring mutual studies. Key in on RFA opportunities,

identify prospect(s) for project idea or interventions involving both groups (keying in on enhancing patient care, quality, and outcomes).

• Explore geographic overlap for possible projects• Devise means for growing network memberships in areas for

critical masses, perhaps via collaborative recruiting (WREN clinics approach the pharmacists they work with to join Pearl-Rx and vice versa)

• Others???

Questions/Suggestions/Ideas?