OCEAN HEALTH INITIATIVES2009

FQHC located in Ocean County, NJSites located in Toms River and LakewoodMobile Van18,866 Patients were served8,100 Hi Risk Patients2,481 Diabetic Patients3,495 Hypertensive Patients

OCEAN HEALTH INITIATIVES

M….MedicationE…. EducationD….DrugS…. Safety

M.E.D.S Team MembersTheresa Berger, CEOShira Meyer, MDPranathi Mandadi, MD Jigna Desai, PharmacistRosemary Faughnan, RNLinda Whitfield-SpinnerKathleen Dagato, ANPMichelle Hutchinson, LPNLynn Walker, LPN Israel Arroyo, Medical AssistantRamdra Villanueva, Medical AssistantKriscia Ramirez, Med TechHannah Maldony, RN DONCarmen Mallamaci, MD CMO

Partner OrganizationsCommunity Medical Center

Provides PharmacistNew Jersey Primary Care Association

Team Member; Provides Guidance and Resources

LabcorpProvides discounted fees for uninsured

patients

PSPC Aim StatementImplementation of Clinical Pharmacy

Services for our highest risk Diabetic Patients who are experiencing Hypertension out of control

GoalsImprove Health OutcomesImprove Pharmacy AccessImprove Patient Safety and Adherence

Bilingual Call Center Staff places reminder calls day before appointment. Patient is instructed to bring all medications to office visit and include OTC

Patient presents to office for appointment at Toms River Internal Medicine Department with Ziploc bag of meds

PAR registers the patient and asks for name of pharmacy. Information is transcribed in EMR to facilitate e -prescribe

Nurse reviews all meds patient brings in and updates med list in EMR. Vitals and BMI taken

Patient evaluated by provider who reviews findings with patient, labs, adjusts meds, e prescribes if patient prefers. Med list updated. Vaccines given if needed and POC Hgb A1C.

Patient meets with nurse who will give updated med list and review meds prescribed. Discharge plans reviewed

If patient does not have insurance enroll patient in patient assistance program. This is done jointly between nursing and social work staff

If pharmacist /pharm student available will meet with patient and provide CPS.

M.E.D.S. Flowchart

Data manager will enter data into spreadsheet

Provider fills tracking form and sends to data manager

Patient is identified as part of PSPC in EMR. Medical Assistant or nurse notes this when processing patient and places tracking form for patient in provider room.

Med Recon. Preventive Care

Program , Disease State Management

Medication Access

Med Reconciliation

Data Collection

What are Clinical Pharmacy Services?Patient-centered services that promote the

appropriateselection and utilization of medications to optimize

individualized therapeutic outcomes Provided by an inter-disciplinary healthcare team

through individualized patient assessment andmanagement

Services best provided by a pharmacist or by anotherhealthcare professional in collaboration with a

pharmacist

Clinical Pharmacy Services ElementsMedication Access Services to PatientsPatient CounselingPreventive Care Programs Drug Information Services to PatientsMedication Reconciliation ServicesProvider EducationRetrospective Drug Utilization ReviewMedication Therapy ManagementDisease State ManagementProspective Chart Review and Provider Consultation

1. Medication Access Services to PatientsUtilization of Drug Programs & Strategies

(340B & Prime Vendor participation, partnerships with charitable & other outside payer groups, enrollment assistance for patients into programs that increase access such as Medicare part D or Medicaid, etc.) with the goal of obtaining a sustainable source of medications for patients that will improve access to care.

Recommend generic alternativePatient Assistance Program

2. Patient Counseling

Patient routinely interacts with a licensed health care provider when medication is picked up.

Follow up phone call from nurse/ma/pharmacist

3. Preventive Care ProgramsMeasure appropriate indicator (BMI, waist

circumference, BP, health questionnaire, etc) and/or administer CLIA Waived test during individual or group screening encounters in order to identify and refer appropriate patient for evaluation and treatment. Administer or refer for immunization.

A1C explained to patientBMI and/or Blood Pressure

4. Drug Information Services to PatientsWritten or verbal patient-friendly and

culturally competent drug information provided to consumers.

Patient Drug Information leafletsDisease State Pamphlets

5. Medication Reconciliation ServicesIdentification of one accurate list of

medications in combination with working directly with the patient or caregiver on their medications, recommendations and changes to therapy as appropriate, facilitation of communication of an accurate list of medications between patient, prescribers, and other health care professionals.

Modified/updated current listMedication List given to patientOTC Meds included

6. Provider EducationDeliver evidence-based medical

information to providers that focuses on the place in therapy and adverse effects associated with the medication.

7. Retrospective Drug Utilization ReviewPeriodic chart reviews in coordination with quality

improvement for the purpose of evaluating organization performance in areas of medication prescribing and/or monitoring. Drug Utilization Reviews can be performed on patient profiles in dispensing and medical charts in primary care environments. Summary of evaluation is presented to clinical staff to support educational efforts, clinical program development as well as development of policies and procedures regarding medication use.

DUR completedADE’s identified and remedied

8. Medication Therapy ManagementNon-drug specific, non-disease specific and

may include polypharmacy management, high risk / high alert medication management, and/or adherence/compliance education. MTM provider considers all medication related needs of the patient, not only those associated with a specific medical condition or therapeutic indication. May include utilization of collaborative practice agreements to create efficiency in patient management processes.

Clinical Modifications made after DUR/ADERecommendations given to patient or provider

9. Disease State ManagementProvision of medication-related assessment and

education within defined medical conditions or therapeutic indications (i.e. anticoagulation). May include utilization of collaborative practice agreements to create efficiency in patient management processes. May include “group visits” that focus on patient evaluation and/or disease-focused education.

Medication modification to obtain goalsLabs ordered

10. Prospective Chart Review and Provider ConsultationProspective review of a patients medical chart for the purpose of providing recommendations to the prescribing practitioner regarding medication adjustments on the day of a medical encounter.

Pharmacist Role at Ocean Health Initiatives

Consult with providers and nurses Assist in medication therapy

What medication to add to regimen

Most cost effective therapy Side effects/drug-interactions

How Clinical Pharmacy Benefits PatientsClinical Pharmacists are usually allotted more

time to spend with the patients vs. their medical provider

Increased Access to CareBetter educated, more informed decision makingPatient Centered CarePharmacists are experts in medication safety

Drug-drug interactionsDrug-food interactionsDrug-disease interactions

How Clinical Pharmacists Benefit Health Center Staff

Provide up-to-date information New GuidelinesNew MedicationsNews reports about medications Provide answers to patient questions before they are asked to medical staff

How Clinical Pharmacists Benefit Health Center Staff

Chart review of difficult to manage patients

Review patients not meeting goalsMeets with provider and patient to

improve patient’s understandingSpend more time educating

patients/family Assists with chronic disease

management

Results of the PSPCPatient Centered CareIntegrated Team Approach to Care

Evidence Based PracticeImproved Staff and Patient Morale

Better Patient Outcomes

Data CollectionDemographics Demographics

Age, gender, ethnicityAge, gender, ethnicityHealth Insurance Health Insurance

Medicare, Medicaid, NoneMedicare, Medicaid, NoneBaseline Health Status and lab tests Baseline Health Status and lab tests

A1C, blood pressure, lipid levels, height, A1C, blood pressure, lipid levels, height, weight, BMI, co-morbid chronic conditionsweight, BMI, co-morbid chronic conditions

Follow up Health Status MarkersFollow up Health Status MarkersCPS VisitsCPS VisitsADEs/pADEs ADEs/pADEs

M.E.D.S DataSeptember 2009 April 2010 POF 35

% Diabetics 100%

% B/P >130/80 100%

% HbA1C >9 25.7%

Avg B/P 153/95

Avg # Chr. Cond./Pt 5

Avg # Medications 6

% Patients E-Prescribe

54%

Avg BMI 34.3

Avg HbA1C 8.8

Average Age 60

POF 35

% Diabetics 100%

% B/P >130/80 69%

% HbA1C >9 8.6%

Avg B/P 143/84

Avg # Chr. Cond./Pt

5

Avg # Medications 6

% Patients E-Prescribe

72%

Avg BMI 32.3

Avg HbA1C 8.13

Average Age 60

M.E.D.S Data

M.E.D.S Data

Rate of pADEs and ADEs

Clinical Pharmacy Services Most Utilized at OHI

Medication Access ServicesPatient Counseling and Follow up Phone

CallsPreventive Care ProgramProvider EducationDisease State Management

AccomplishmentsObtained Hemoglobin A1C machine

Prevents pADE/ADEPositive Reinforcement for Patients/StaffMedication Adjustments made in Real TimeImproved ComplianceProvided at low cost to uninsured patientsImproved Patient Outcomes

AccomplishmentsWeekly team meetings for case managementImproved Patient OutcomesPatient/Staff AwarenessFamily Centered CareCommunity Partners for Patient/Staff

EducationRevising EMR template to capture CPS Administrative and BOD Support

Case Presentation52 year old male with

h/o uncontrolled Diabetes and Hypertension began CPS 10/09. Services he received included: CPSNutritional CounselingEnrolled in MedicaidMedication

ManagementPatient Education

Hemoglobin A1C

12.9

7.1

0

20Jul-09

Feb-10

Date Blood Pressure

10/20/09 150/100

12/1/09 140/98

2/24/10 128/84

ChallengesHigh number of patients are uninsuredMany have more than one chronic medical

conditionRise in medication cost and “polypharmacy”Providers are pressured to see more patients faster

resulting in greater patient safety risk and lower patient satisfaction

Maintain high quality of care within time restraintsData CollectionIncrease CPSSpread

OHI M.E.D.S Team