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5 insights for expanding the role of pharmacists in ambulatory care

September 21, 2017

    As the shift from volume to value increasingly drives care into the ambulatory setting, engaging individuals and populations in self-care and preventive care will become even more important. As we've previously noted, clinical pharmacists are often an underutilized asset in achieving these aims.

    Based on conversations with Carilion Clinic around lessons learned from the IHARP model, which embedded pharmacists in patient-centered medical homes, here are five key insights to keep in mind if you're considering expanding the role of clinical pharmacists outside of the inpatient setting:

    1. Set patient inclusion criteria based on strategic decisions about how to allocate limited resources

    Carilion's IHARP pharmacists focused on patients with multiple chronic conditions and excluded individuals in the last six months of life. Specifically, Carilion aimed to demonstrate the longitudinal impact of pharmacy intervention on the management of chronic conditions.

    Another health system in the Midwest took the opposite approach, focusing ambulatory clinical pharmacists on supporting patients at the end of life.

    This facility sought to support a growing palliative care offering and to preserve visit volumes for primary care providers. The difference in strategy was influenced by organizational objectives and physician preference regarding which patients would most benefit from pharmacy support.

    Our research on Integrating Pharmacists into Primary Care has shown that other inclusion criteria can vary by institution, including the number of medications used to define polypharmacy and the number and type of health conditions required for participation.

    2. Provide additional training to help pharmacists assume the expanded scope of responsibility

    IHARP leaders noted that pharmacists trained to work in the hospital setting seldom have experience working in retail or primary care clinic. Ambulatory settings require different skills and process knowledge. Consequently, educating pharmacists about the differences between settings can improve collaboration. The most critical skills to teach them include motivational interviewing and shared decision-making.

    3. Grant community pharmacists access to your EHR

    Using a shared record enables messaging among care team members and provides a central platform for viewing relevant patient information and documenting interventions. Carilion relied on the active participation of their IT department for both EHR customization and staff training.

    4. Prioritize provider support and patient satisfaction

    Embedding a pharmacist in primary care requires gaining acceptance from physicians, advanced practitioners, and care coordinators, as well as building trust, rapport, and effective workflows. To do so, you should clearly explain the benefits a pharmacist can offer the care team and patients upfront and regularly offer quantitative updates on value provided (e.g., improvements in clinical indicators, patient satisfaction).

    Similarly, patients likely are not accustomed to working with a pharmacist in a clinical setting. Positioning pharmacy services as an active collaboration among the primary care clinical pharmacists, physician, and community pharmacist can help patients understand the pharmacist's role.

    5. Choose clinical and quality outcomes carefully, and monitor and report them regularly

    Performance metrics illustrate the integrated model's cost and quality improvement benefits, while also facilitating learning across sites. In addition, these data can be used to build a business case to present to commercial payers.

    Here's a look at the measures tracked under the IHARP model: medication-related problems (MRPs) identified, pharmacist interventions to solve MRPs, provider acceptance rate of proposed interventions, clinical measures (e.g., HbA1c, LDL, blood pressure), estimated cost avoidance associated with interventions, patient satisfaction, and number of ED visits and hospitalizations.

    Read our top resources to staff pharmacists in primary care

    Explore our top resources and case studies to support leaders as they either start or expand their primary care pharmacy program.

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