Nearly half of all Americans use prescription drugs. The number of people taking five or more jumped to 15% in 2012. Studies show that the more medications a person takes, the greater the chance that they will be taken incorrectly or that drug–drug interactions will occur. (Pictured at right: Joe Vande Griend, PharmD, and My "Mimie" Giang, MD)
Yet there is no one-size-fits-all approach when it comes to managing medication. Patients have individual needs and it takes time and specialized knowledge to perform a thorough medication review. With demand for physician services outstripping supply, many physicians simply don’t have the capacity and in some cases the detailed knowledge.
Enter Joe Vande Griend, PharmD, and Colleen Conry, MD, from the University of Colorado School of Medicine (SOM). Dr. Conry is senior vice chair for quality and clinical affairs for the Department of Family Medicine and Dr. Vande Griend is associate professor at the Skaggs School of Pharmacy and Pharmaceutical Sciences and the SOM Department of Family Medicine.
Dr. Conry explains that the University of Colorado Hospital has long recognized the value of clinical pharmacists. Pharmacy consults at the Department of Family Medicine residency clinic began in 1998. Here, pharmacists provide vital education, advice and medication reviews. Although this service offers significant benefits, the department was unable to expand it to their community practices due to budget restraints.
“Small practices that may only receive 12–14,000 visits per year would likely be unable to justify hiring a full-time pharmacist,” Dr. Conry said. “Yet pharmacists have a body of knowledge about medications that is immensely valuable to patient care, and it was important that we find a way to share those benefits with smaller practices.”
In 2011 Drs. Vande Griend and Conry applied and received funding for a remote pharmacy consult service through the Primary Care Strategic Initiative Grant Program, which allowed them to pilot pharmacy e-consults at their Park Meadows clinic (now Lone Tree). The lead physician for this pilot was Debra Bislip, MD, assistant professor of family medicine. The pilot was so successful that the Department of Family Medicine took over funding once the grant ended. The team has since extended the service to their Westminster and Boulder clinics.
“Physicians are dealing with so many things during a patient visit,” Dr. Vande Griend explained. “They don’t necessarily have time to perform an intense medication review or spend significant time talking to the patient about their medications. Now pharmacists can work in concert with the physician to extend the services they provide. Because we’re so specialized, we’re able to spend 30 minutes just focusing on the medication details.”
And those details can make a big difference. Using a pharmacist-driven targeted approach, the Westminster clinic has seen pneumococcal vaccination rates rise from 48% to 80% for patients aged 65 and over – another win for the service, which recently earned a Clinical Innovation Challenge Award from the American Association of Medical Colleges.
Dr. Vande Griend explains that the success of his initiative hinges on two aspects: access to patients’ electronic medical records and the pharmacist’s relationship with the provider.
To optimize the former, Dr. Vande Griend developed an algorithm in Epic that functions as a risk stratification score: patients with complex medical needs, such as elderly patients who take multiple medications, appear at the top. The pharmacist can then perform targeted chart reviews and make recommendations in Epic regarding possible medication changes, due to things like drug–drug interactions or medications that are less effective than once thought. The provider receives these recommendations and decides whether to implement them at the patient visit. Providers can also contact the pharmacist through Epic for drug information requests or patient consults.
Though Dr. Vande Griend provides most of his consults remotely, he and a pharmacy resident visit each of their outlying clinics for half a day a week.
“These face-to-face meetings are really important,” he said. “My job is to make providers’ lives easier, not more difficult, and we spend a lot of time building relationships so that providers feel comfortable using the service and coming to us with questions. It also allows us to establish a two-way communication, where we can learn from each other to improve the quality of care.”
In order to make the most of a pharmacy consult service, Dr. Vande Griend proposes, there needs to be a professional working relationship between the three key players in the process: the patient, the physician and the pharmacist.
“Family medicine is team based and continually becoming more so,” he said. “When you have two-way communication with the physician, the effectiveness of the clinical pharmacist is raised significantly. When you add in access to the patient you can really achieve optimal medication efficacy.”
Drs. Vande Griend and Conry hope to use their success with the pharmacy e-consult service to expand across a much larger area, covering rural communities and continuing to enhance clinical pharmacy services at their larger clinics like Anschutz and Lowry Internal Medicine.
“This initiative is a really good example of how multidisciplinary teams can work together to improve patient care,” Dr. Conry said. “We’ve been very successful in showing that it works and impacts patient care in a positive way, and now we’re looking forward to expansion in the future.”
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