By Devin Schmidt, Pharm.D., BCACP, ambulatory care pharmacist, Mercy Health Muskegon
Ambulatory care pharmacist leaders came together at the Michigan Society of Health-System Pharmacists (MSHP) Ambulatory Care Pharmacy Practice Leadership Conference in September to discuss ways to advance pharmacy practice and increase patient access to pharmacists’ care, a goal of the 2014 MSHP Ambulatory Care Summit. The conference focused on utilizing the American Society of Health-System Pharmacists (ASHP) Ambulatory Care Self-Assessment Tool www.AmCareAssessment.org) to expand new ambulatory care sites, determine how existing sites align with the 2014 ASHP Ambulatory Summit recommendations and create site site-specific action plans to improve practice. In addition to self-reflecting on our sites, speakers from across the State presented on their current practices.
The first speaker, James Kalus, Pharm.D., FASHP, director of pharmacy and PGY1 residency program director at Henry Ford Hospital, Detroit, provided a director's insight on ambulatory care services. Dr. Kalus described the many opportunities in ambulatory care pharmacy practice, including patient impact and adding value by encouraging high-quality care and improving patient outcomes. These opportunities should be measured with quality metrics while also tracking pharmacist workload combined with both direct and indirect financial impact. Dr. Kalus provided information on expansion of services and key factors needed to grow services including financial considerations, physician and administrator buy-in, tools to support the growing practice and a measurable plan.
Following a director’s perspective, Nancy MacDonald, Pharm.D., BCPS, FASHP, transition of care coordinator at Henry Ford Hospital, Detroit, described her role within transitions of care practices at her site. The transitions of care consult program focuses on performing a medication history and adherence evaluation. Disease-specific consultations to optimize medications are provided as well as education for patients being discharged with a new medication and also those at high risk for readmission or non-adherence. Additionally, patients are referred to ambulatory care pharmacists in the outpatient setting, when appropriate, for a follow-up. This successful program at Henry Ford Hospital is a great blueprint for sites looking to initiate or improve their transitions of care process.
Next, Angela Green, Pharm.D., BCPS, ambulatory pharmacy services manager and Devin Schmidt, Pharm.D., BCACP, ambulatory care pharmacist, both with Mercy Health Muskegon, presented an overview of their ambulatory care model. Mercy Health has pharmacists embedded in 13 office practices, three specialty practices and three anticoagulation clinics. These pharmacists collaborate with other healthcare professionals to provide medication and chronic disease state management. Patient care is provided both directly with face-to-face and telephonic visits and indirectly through answering drug information questions, addressing medication coverage concerns and unmet quality metrics. Mercy Health is hoping to continue expanding their services to provider offices in the community as well as the rural areas in the northern network.
After discussion of services at Mercy Health, Candice Garwood, Pharm.D., FCCP, BCPS, clinical pharmacy specialist at Harper University Hospital, Detroit, described the geriatric primary care clinic model used at her institution. Within this clinic, pharmacists have several responsibilities including a pharmacotherapy clinic, collaborative visits, chronic care management, an anticoagulation clinic and transitions of care medication information, reconciliation and access. These services are provided face-to-face and telephonically. These may be billed for a facility fee, under chronic care management or transitional care management codes.
Lastly, Lianne Granata, Pharm.D., clinical pharmacist specialist at University of Michigan, Ann Arbor, outlined clinical practice pearls for establishing an ambulatory care site. Currently, Dr. Granata practices within a family medicine clinic providing disease state management services and comprehensive medication reviews. Drawing on her experience starting previous sites, Dr. Granata discussed ways to engage the practice, including providing examples of how pharmacists can add value to both providers and patients while collaborating with all levels of staff within the practice. Proactively identifying and recruiting patients, as well as having specific productivity targets, is strongly encouraged during the early stages of a new site.
The journey to increase patient access to pharmacist care and advance pharmacy practice is being navigated by many. Together, as a group of hardworking pharmacists, we can continue to embark on forwarding our goals for patient care by sharing best practices, discussing barriers and encouraging each other to progress our current state.