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A prescription for the politics of integrated care

July 28, 2017

    Even the best laid plans for greater care integration can fail because of politics. Tribalism, suspicion, and turf wars loom large even in areas where we all agree we have opportunities to do better.

    And that's not because of malicious intent. In fact it's often quite the opposite—several providers, committed to doing the best for the patient, all want to guarantee that the patient will get the care they need. That can lead to a sense of "ownership" of the patient that makes cross-continuum teamwork harder.

    One potential way forward is to introduce a team mate who is not seen as a potential competitor but rather a partner in care delivery. For many health systems, that's the pharmacist.

    Poly-pharmacy a rising concern

    One of the chief reasons we are racing to connect services is that our patients are more complex. Today more patients are managing more long-term conditions, and with that a more complicated drug regimen.

    Massachusetts General Hospital in the United States found that their typical high-risk patient has prescriptions for 12 different drugs. With so many medications to take, patients can easily miss or confuse the drugs they're taking. Furthermore, when patients—particularly those on multiple medications—experience a hospital admission, one or more of their medications may change upon discharge. This further complicates the situation, and often leads to unnecessary readmissions. This is a perfect opportunity to bring in the pharmacist to support and coach the patient.

    Pharmacists can be the cross continuum "glue"

    That's exactly what the Northumberland group in the UK did in partnership with their local GP practices. Since the relatively smaller GP clinics couldn't afford the insurance to employ a pharmacist themselves, the hospital "lent" them senior acute clinical pharmacists. Their job was to spend time helping patients with their medication protocols in clinics and on home visits.

    The results have been a win-win for everyone. The providers have been able to shift 30% of home visits to the pharmacist, thereby freeing up additional GP capacity. The hospital is able to help reduce inappropriate readmissions and visits to the ED. And behind the scenes the clinicians all acknowledge that they never worry the pharmacist is encroaching on their turf, because their skillset is needed and additive. In fact, one participant told us "the pharmacists love operating in new models. They're the glue of the multi-disciplinary team."

    Politics, while ever-present in health care, are not always the primary concern when we're developing new models of care. But as the example from Northumberland shows, pharmacists are potentially under-utilised but critical players who can help patients with long-term conditions succeed at managing their conditions without stepping on anyone's toes.

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