Using the Pharmacists’ Patient Care Process to Manage High ......Jun 01, 2017 · overall health...
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USING THE PHARMACISTS’ PATIENT CARE PROCESS TO MANAGE HIGH BLOOD PRESSURE AND DIABETES Hannah Herold, MPH, MA, CHES
Transcript of Using the Pharmacists’ Patient Care Process to Manage High ......Jun 01, 2017 · overall health...
USING THE PHARMACISTS’ PATIENT CARE PROCESS TO MANAGE
HIGH BLOOD PRESSURE AND DIABETES
Hannah Herold, MPH, MA, CHES
About Me
Public Health Consultant
Cardiovascular Health Team
National Association of Chronic Disease Directors
Public Health ConsultantHerold LLC
Objectives
■ Summarize the role of a pharmacist in chronic disease prevention and
management.
■ Describe the impact of medication adherence/non-adherence on chronic disease
management.
■ Apply the five steps of the Pharmacists’ Patient Care Process to chronic disease
patient care.
The Growing Burden of Chronic Disease
45% of the U.S. population has at least
one chronic disease.
Chronic diseases are the
leading cause of death and
disability in the U.S., and
account for 7 out of every
10 deaths.
Centers for Disease Control and Prevention. Chronic Disease Overview page. Available at: https://www.cdc.gov/chronicdisease/overview.htm.
Accessed June 1, 2017.
Wu, Shin-Yi, and Green, Anthony. Projection of Chronic Illness Prevalence and Cost Inflation. RAND Corporation, October 2000.
118125
133141
149
157164
171
44.7%
45.4%
46.2%
47.0%
47.7%
48.3%
48.8%49.2%
40
41
42
43
44
45
46
47
48
49
50
0
20
40
60
80
100
120
140
160
180
1995 2000 2005 2010 2015 2020 2025 2030
Pe
rce
nt
of
Pe
op
le w
ith
Ch
ron
ic C
on
dit
ion
s
Nu
mb
er
of
Pe
op
le w
ith
Ch
ron
ic C
on
dit
ion
s (
millio
ns)
Year
The Number of People with Chronic Conditions is Rapidly
Increasing
Number Percent
The Cost of Chronic Disease
In 2010, the U.S. spent
$2,236,000,000,000on healthcare costs for people
with one or more chronic
diseases.
Centers for Disease Control and Prevention. Chronic Disease Overview page. Available at: https://www.cdc.gov/chronicdisease/overview.htm.
Accessed June 1, 2017.
All Healthcare Spending Medicaid Spending Medicare Spending
Percent of Healthcare Spending on Patients with One or More Chronic Diseases, 2010
86% 83% 99%
Partnership for Solutions. Chronic Conditions: Making the Case for Ongoing Care. September 2004 Update. Available at:
http://www.rwjf.org/files/research/Chronic%20Conditions%20Chartbook%209-2004.ppt.
No Chronic Conditions
14%
1 Chronic Condition
15%
2 Chronic Conditions
13%
3 Chronic Conditions
12%
4 Chronic Conditions
11%
5+ Chronic
Conditions
35%
Total U.S. Healthcare Spending by Number of Chronic
Conditions in 2010
Gerteis J, Izrael D, Deitz D, LeRoy L, Ricciardi R, Miller T, Basu J. Multiple Chronic Conditions Chartbook. AHRQ Publications No, Q14-0038.
Rockville, MD: Agency for Healthcare Research and Quality; 2014.
The Impact of Chronic Disease
45.1% of people with multiple chronic conditions have activity limitations.
This includes limitations on:
• Bathing
• Toileting
• Dressing
• Eating
• Walking or Moving Around
• Preparing Meals
• Housework
• Shopping
• Taking Medications
• Using Transportation
• Sensory Perception
A Transformation in Healthcare
Infectious Disease Chronic Disease
Acute Care Model Chronic Care Model
Fee-for-Service Payment Fee-for-Outcome Payment
Collaborative Care
Patient-Centered Medical Home
Medication Therapy Management
Pharmacists’ Patient Care Process
Medication Dispensing
WHY INVOLVE PHARMACISTS IN CHRONIC DISEASE MANAGEMENT?
Primary and Secondary Prevention
Prevent Disease
■ Immunization
■ Disease Screening
■ Tobacco Cessation Assistance
■ Preventive Health Education
Reduce Impact of Disease
■ Medication Therapy Management
■ Disease Self-Management
Education
■ Follow-up Care
2.8 3.7 4.96.5
7.9
11.6
3.5
8
14.3
22.8
30.8
50.2
0
5
10
15
20
25
30
35
40
45
50
55
0 CC 1 CC 2 CC 3 CC 4 CC 5+ CC
Average Annual Visits to Clinician and Number of
Prescriptions Filled, by Number of Chronic Conditions (CC),
2010
Visits to Clinician Number of Prescriptions Filled
Gerteis J, Izrael D, Deitz D, LeRoy L, Ricciardi R, Miller T, Basu J. Multiple Chronic Conditions Chartbook. AHRQ Publications No, Q14-0038.
Rockville, MD: Agency for Healthcare Research and Quality; 2014.
Medications are one of the foundations of chronic disease management.
91% of all filled
prescriptions are for patients with chronic conditions.
Gu Q, Dillon CF, Burt VL. NCHS data brief, no 42. Hyattsville, MD: National Center for Health Statistics. 2010.
$8,812 $6,959 $6,237 $5,887 $3,808
$55
$165
$285$404
$763
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
$8,000
$9,000
$10,000
1 - 19% 20 - 39% 40 - 59% 60 - 79% 80 - 100%
Ave
rage
Exp
en
dit
ure
s p
er
Ye
ar
Adherence Level (% Days Supply/1 Year)
Diabetes Medication Adherence and Total Diabetes Healthcare
Costs
Medical Cost Medication Cost
Sokol MC, McGuigan KA, Verbrugge RR, Epstein RS. Impact of medication adherence on hospitalization risk and healthcare cost. Medical Care.
2005;43:521-530.
30%
26%25%
20%
13%
0%
5%
10%
15%
20%
25%
30%
35%
1 - 19% 20 - 39% 40 - 59% 60 - 79% 80 - 100%
Ris
k o
f H
osp
ita
liza
tio
n (
%)
Adherence Level (% Days Supply/1 Year)
Diabetes Medication Adherence and the Risk of
Hospitalization
Hospitalization Risk Linear (Hospitalization Risk)
Sokol MC, McGuigan KA, Verbrugge RR, Epstein RS. Impact of medication adherence on hospitalization risk and healthcare cost. Medical Care.
2005;43:521-530.
THE PHARMACISTS’ PATIENT CARE PROCESS(PPCP)
What is the PPCP?
■ A uniform, consistent
patient care process for
pharmacists
■ Developed by the Joint
Commission of Pharmacy
Practitioners in May, 2014
■ Gives patients routine
expectations for patient
care services at pharmacy
Bennett, M., & Kliethermes, M. A. (2015). How to implement the pharmacists patient care process. Washington, DC: American Pharmacists
Association.
Collect the key information necessary for services the pharmacist is being asked to perform.
■ Collect subjective and objective information about the patient
■ Current medication list and medication use history
■ Relevant health data
– Medical history
– Health and wellness information
– Biometric test results
– Physical assessment findings
■ Patient lifestyle habits, preferences and beliefs, health and functional goals, and socioeconomic factors
For Each Medication:
• Indication
• Generic and Trade Name
• Dose
• Route of Administration
• Special Instructions
• Date medication was started
• Prescribing Provider
• Refill Date
Additional Content:
• Allergies
• Source of current list
• Date of current list
• Providers and contact info
• Medication History
Bennett, M., & Kliethermes, M. A. (2015). How to implement the pharmacists patient care process. Washington, DC: American Pharmacists
Association.
Analyze information collected from step 1 and identify and prioritize patient problems.
■ Assess each medication for appropriateness, effectiveness, safety, and patient
adherence
■ Health and functional status, risk factors, health data, cultural factors, health
literacy, and access to medications or other aspects of care
■ Immunization status and the need for preventive care and other health care
services, where appropriate
– Preventive care needs are determined based on medical history, family history,
laboratory values, current disease states, and environmental factors
Bennett, M., & Kliethermes, M. A. (2015). How to implement the pharmacists patient care process. Washington, DC: American Pharmacists
Association.
Development of an individualized patient-centered care plan in collaboration with other
health care professionals, the patient, and the patient’s caregiver.
Care plan should be evidence-based, and cost-effective.
■ Address medication-related problems and optimize medication therapy
■ Set goals of therapy for achieving clinical outcomes in the context of the patient’s
overall health care goals and access to care
■ Engage the patient through education, empowerment, and self-management
■ Support care continuity, including follow-up and transitions of care as appropriate
Bennett, M., & Kliethermes, M. A. (2015). How to implement the pharmacists patient care process. Washington, DC: American Pharmacists
Association.
In collaboration with other health care professionals,
and patient or caregiver, implement the care plan.
■ Address medication- and health-related problems
and engage in preventive care strategies
■ Initiate, modify, discontinue, or administer
medication therapy as authorized
■ Provide education and self-management training
■ Contribute to coordination of care, including
referral or transition of the patient to another
health care professional
■ Schedule follow-up care as needed to achieve
goals of therapy
SBAR steps
Situation
Background
Assessment
Recommendation
SOAP Note steps
Subjective
Objective
Assessment
Plan
Bennett, M., & Kliethermes, M. A. (2015). How to implement the pharmacists patient care process. Washington, DC: American Pharmacists
Association.
Monitor and evaluate the effectiveness of the care plan, and modify the plan in
collaboration with other healthcare professionals and patient or caregiver as needed.
■ Review medication effectiveness, and safety and patient adherence through available
health data, biometric test results, and patient feedback
■ Evaluate clinical endpoints that contribute to the patient’s overall health
■ Assess outcomes of care, including progress toward the achievement of goals of therapy
Clinical Measures Humanistic Measures Economic Measures
Blood pressure Patient medication knowledge Hospitalizations
HbA1C Patient functioning Emergency department visits
Medication problem resolution Self-management capability Medication costs
Adverse drug events Satisfaction
Adherence
Bennett, M., & Kliethermes, M. A. (2015). How to implement the pharmacists patient care process. Washington, DC: American Pharmacists
Association.
PPCP: A Transformation in Pharmaceutical Healthcare
Time
Inte
nsit
y
Traditional Model of Care
Time
Inte
nsit
y
Pharmacist Patient Care Process Model
Assessing Capacity for Implementation of the PPCP
Implement the PPCP
Develop Quality Improvement
Strategies
Evaluate Existing Services
Bennett, M., & Kliethermes, M. A. (2015). How to implement the pharmacists patient care process. Washington, DC: American Pharmacists
Association.
Benefits of Integrating Pharmacists into the Patient’s Health Care Team
Control of
Chronic
Conditions---
Healthcare
Outcomes
Fragmentation
of Care---
Healthcare
Costs---
Risk of
Hospitalization
Centers for Disease Control and Prevention. Advancing Team-Based Care Through Collaborative Practice Agreements: A Resource and
Implementation Guide for Adding Pharmacists to the Care Team. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of
Health and Human Services; 2017.
Wyoming Collaborative Practice Law
“A Collaborative Pharmacy Practice is that practice of a
pharmacy whereby one or more pharmacists have jointly agreed, on a voluntary basis, to work in conjunction with one or more
practitioners under protocol and in collaboration to provide
patient care services to achieve optimal medication use and desired patient outcomes.”
Wyoming Pharmacy Act Rules & RegulationsChapter 2
A Collaborative Practice Agreement (CPA) is a written
and signed voluntary agreement that creates a
formal practice relationship between a pharmacist and a
prescriber.
The Steps towards Implementing a CPACollaborative Practice Agreements are built on a relationship of trust between
Pharmacist and Prescriber.
Pharmacist
dispenses
prescriber’s
prescriptions.
Pharmacist and
prescriber ask
questions and
exchange
information.
Pharmacist makes
recommendations;
prescriber strongly
considers and often
accepts
recommendations.
Prescriber delegates
responsibilities under a
collaborative practice
agreement.
Centers for Disease Control and Prevention. Advancing Team-Based Care Through Collaborative Practice Agreements: A Resource and
Implementation Guide for Adding Pharmacists to the Care Team. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of
Health and Human Services; 2017.
PPCP IN WYOMING
Survey of Wyoming Pharmacies
In a 2019 online survey of
Wyoming pharmacies, 68.5% of
survey respondents (n=54)
indicated they did not
implement any strategies for
applying the Pharmacists’
Patient Care Process to existing
patient care services.
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Provide feedback to primary care physician regarding
patient medication adherence/non-adherence
Specifically monitor refill records to observe if patient is
adhering to medication regimen over time
Automated patient refill reminders
Prescription synchronization
Educate on dosage/frequency/side-effect/contraindication
Educate on the importance of following prescribed
medication regimen
Percent of Respondents Implementing Strategy
Pharmacy Actions to Support Medication Adherence
Hypertension Diabetes Cholesterol
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Refer patients who use tobacco to the Wyoming Tobacco
Quitline
Make referrals to community education programs
Screen patients for disease
Provide general physical activity information
Provide general nutrition information
Percent of Respondents Implementing Strategy
Pharmacy Actions to Support Lifestyle Behavior Change
and Education
Hypertension Diabetes Cholesterol
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Follow up with patients on individual care plans for disease
management
Work with patients to develop individual care plans for
disease management
Recommend home monitoring with supervision and report
back to provider
Offer pharmacy monitoring with supervision and report back
to provider
Percent of Respondents Implementing Strategy
Pharmacy Actions to Support Patient Self-Management of
Disease
Hypertension Diabetes Cholesterol
RESOURCES
Resource Book
How to Implement the
Pharmacists’ Patient Care
Process
Available for purchase from
APhA, Amazon, and other
textbook vendors.
Resource Guide
Using the Pharmacists’ Patient
Care Process to Manage High
Blood Pressure: A Resource
Guide for Pharmacists
Resource Guide
Collaborative Practice
Agreements and Pharmacists’
Patient Care Services
QUESTIONS?Contact:
Hannah Herold, MPH, MA, CHES Hannah Herold, MPH, MA, CHES
Public Health Consultant Public Health Consultant
National Association of Chronic Disease Directors Herold LLC
