Sorry for the delay in getting this posted; I had a lot of trouble getting my hands on the article for this topic. This site has a pretty good overview of the concept of the patient-centered medical home along with links to other sites that have additional information. The article describes the role of the pharmacist within this new system.
As you read through these items, consider how pharmacist friendly the general descriptions of this concept are. What are additional roles the pharmacist could fill that are not mentioned in these descriptions of a patient-centered medical home?
28 comments:
Pharmacists play an important role in Patient-centered medical home. In the article, they talk about how pharmacists bring MTM to medical home. They help physicians in drug therapy plan, counseling patient, decreasing drug use errors, etc.
Pharmacists will create a long relationships to patients they take care of; this will be very helpful to patients. Patients will have easy time when taking medication and have following-up or following-through process. Moreover, pharmacists will be almost 24/7 if their patients have some accidental problems; hence, patients will be taken care more carefully. Pharmacists will not affected by any financial interest from drug companies; so they will help patient choose wisely drug plan and help them reduce costs. I think there are a lot more pharmacists can do for patients in the real world; and we all are trying our best to complete our mission.
Ngan Tran - P1
Currently, I feel that Pharmacist's do not play the role the should in the Patient-Centered Medical Home (PCMH). Too many pharmacists today are worried about how many prescriptions they filled and are not using their education, knowledge, and availability to the patient to the best of their ability. They have the opportunity to use MTM, further patient education, initiate public health initiatives, and many other things to contribute to the PCMH. The opportunity is right there in their faces; patients usually see a pharmacist far more often than they see their physician and it is this opportunity the pharmacist must grab. Establishing a Patient-Centered relationship will only improve the lives of those patients, save the healthcare system money, and solidify the Pharmacist role as a healthcare profession.
Greg Browning; P-1
According to the article Medical Home 101, it seems that the role of the pharmacist in the medical home is needed and useful. Reviewing the 10 steps of MTM that Dr. Linda Strand identified in the article makes it clear that the role of a pharmacist performing MTMs in the medical home is a way that the PharmD can apply the skills acquired during the 4 year PharmD program. Clearly the pharmacist can take even more load off of the physician by taking the responsibility of providing the 10 steps listed. This will benefit the patient as it focus on each individual’s positive outcome and prevention of disease states.
Through the use of a collaborative agreement between the pharmacist and the physician the patient will receive the ultimate benefit from the use of their medication regimen that had been selected by the physician. Upon the diagnosis and prescribing for a patient, the physician can refer the patient to the in house or off site pharmacist to then spend time with the patient educating and assisting the patient with their medication adherence. This could potentially eliminate some of the readmitted people to the emergency rooms or hospitals and free the physicians up even more for the serious conditions or medical emergencies. It makes perfect to sense to utilize the pharmacist in this way because they are the experts in medication. The physician is trained to diagnose and treat, so each expert should be free and available to concentrate on their specialized area for the maximum benefit for each patient. The article states the above mentioned very precisely and I agree with the closing statement made by Margherita Giuliano in regard to the newly graduating PharmDs. The education that has been provided places them in a position to read labs, perform in depth assessments of the patients’ needs and goals in regard to their medication regimen needs. The PharmD is the perfect candidate for the role of a health care provider and should absolutely be added to the team of trusted professionals in the patient- centered medical homes.
To the mentors: What is your opinion about the future of the role of the pharmacist in the patient- centered medical home? Do you feel it is something that you personally would want to pursue? Do you see it as a role of the pharmacist in the near future?
Tiffany Benfield P1
I agree with Greg on this. Many pharmacists are not doing the job they could be doing. They work half of what they could be doing for over $100,000 a year and that's just fine. We must jump at the opportunities we're given, even if it's only counseling more thoroughly. Furthermore, the chance to create patient-centered relationships are something we all must strive for BECAUSE of our accessibility. We have the best potential to improve patient lives and well-being because of this. It shouldn't be something we turn our back on.
I think there is a big need for pharmacists in patient cantered medical homes. The information that the pharmacist could provide to the medical home would be endless and the rewards would by far outweigh the costs of employing a pharmacist to help out. Like the article had mentioned, doctors would be freed of the homework that they are forced to take home nightly with them. Not only will the physician not remember as much about the patient when they are at home, but there is also the risk of confusing patients and medication records. I think have a pharmacist on duty to monitor doses, review complete patient medication records, and help the patients with medication compliance would serve to not only help lighten the pharmacists work load, but also increase the quality of life for the patients who will be receiving this optimal care.
Pharmacists have the potential to play an important role in the patient-centered medical home (PCMH). I feel that up to this point, pharmacists have not participated in the PCMH. However, I feel that pharmacists would be an excellent contribution to a healthcare team at a PCMH. Though this example is definitely a Hollywood version where diagnoses are always made and patients are always cured in an hour, think of the good a pharmacist could do for "House" and his diagnostic team. Now I doubt any diagnostician is as "good" as "House," and therefore, I think a pharmacist could contribute their knowledge of medications to diagnosing and implementing a treatment plan for patients.
The article brought up a good point that, "While the pharmacist’s responsibility
may be to address a particular
disease state or issue, he or she
works as part of a team to address all the patient’s health needs." As it applies to PCMH, each member can contribute their strengths to address the needs of the whole patient while focusing on specific disease states through MTM.
P1 - Amanda Flores
The medical-home model was developed to provide patient-centered care using a team approach. Pharmacists have a significant in impact of medical home care. The pharmacists’ role can establish relationships between the pharmacists, healthcare providers and the patients. Second, they create a comprehensive medication profile including over-the-counter and herbal medications and review this for any discrepancies and appropriateness of therapy. Plus, their duties in the medical homes give physicians free time to focus on other clinical activities. These are few of the reasons why pharmacists are beneficial to medical homes.
Unlike community pharmacies, pharmacists would be able to maintain a long term relationship and get a thorough medical background for the patient in a medical home facility. Pharmacists would have access to patient medications, past and present disease states, lab work, etc. at their fingertips. While physicians may not have time to discuss patient's medications in a where most patients are taking a large number of medications. A pharmacist in a long term care facility would be beneficial, as they would be able to conduct extensive drug therapy review and closely monitor patients' drug regimens.
While this is a great opportunity for pharmacists, I do agree with Greg that currently, the profession is not playing a large part in patient centered medical home care. However, the type of patients that are in medical home facilities are the same ones that have the most amount of medications. This should in fact give medical homes more incentive to hire pharmacists.
I think for the most part the article expressed the pharmacist's role in the patient-centered medical home model accurately. However, the main role was that of MTM and managing the patient's drug regimen after everything had been prescribed. If the pharmacist is supposed to have that teamwork relationship with the head physician then they should have a voice in prescribing and altering the drug regimens. Also I think that the main issue with the pharmacist's role in this model is that of reimbursement. Now that other members of the team are seeing the value of pharmacists the next step is making this model more of a reality by resolving the issues of payment.
Chad Chriscoe P1
I see quite a few students faulting the pharmacist for not doing their job, or going above and beyond filling prescriptions in their pharmacy, when in reality, their time is limited. I have work as a technician in multiple stores within one company. One store would average 175 prescriptions while another store would average 300 daily. Both stores ran with one pharmacist. The first store with 175 prescriptions is an ideal place to do MTMs. We had time to call the physicians for refills and drug changes. The pharmacist did several consults and had time to show patients how to use glucose monitors. I spent most of my time in the store doing 300 prescriptions and we were lucky, with 4 technicians, off and on all day, to call the doctor during business hours for refills. Forget about the pharmacist leaving the computer to recommend an OTC product between the hours of 9 and 5. We relied on faxing and hoping the nursing staff would get back to us within 2 business days for refills. I believe a patient centered approach is best for the patient, but until the business restraints are lifted off the pharmacists by the pharmacy companies, this approach will be limited in the community pharmacy setting. We have to be able to bill insurance companies and show the big chains, as a MTM focused pharmacist, how we can make them money using this approach.
P1 Tyrsa Creel
I agree with Chad. In order to fully utilize a pharmacist in a patient centered medical home, pharmacists should have some sort of autonomy. They need to be allowed to have a say in drug therapeutics for different disease states. The pharmacist's role described now in the PCMH is mainly doing MTM and this role is a very good example of patient centered care. We will not be able to see this type of care in a community setting however until the issue of payment by insurance companies is taken care of. Corporations are focused on one thing....money. If their pharmacists are doing tasks that they are not going to be able to cash in on then it will be out of the question. However if pharmacists were able to get set up to bill for MTM services easily then the community chain pharmacists might be able to have more of a chance to do MTM because the corporations in charge of them will see that there is money to be made in those particular services.
There are core principles of the patient-centered medical home
-Team approach
-Comprehensive
-Coordinated
-Quality safety
-Access
-Value
-Personal relationship
http://www.cthealthpolicy.org/webinars/20100217_pharmacists_medical_home.pdf
Ngan Tran - P1
The idea of a patient centered medical home is certainly the way forward and i can say with great faith that its the future. Advancement in technology will lead to more drugs in the market and complexity in therapies and ultimately increase the need for pharmacists in all care settings. This is a great opportunity that pharmacist need to seize and as the article puts it, "prove" themselves. These are the kind of avenues of opportunity we need to embrace instead of complaining that technology and things like central fill will take away pharmacy jobs. Patient centered medical home; a great opportunity for pharmacists to go after.
Jonathan Mwathi
I feel that the patient-centered medical home model is a great opportunity for pharmacists both currently and in the future. My sister, who is a primary care clinical pharmacist at the VA Medical Center, was telling me that this model is currently being implemented by the VA and is projected to go into full effect within the next couple of years. She said that currently there is about one pharmacist to every seven or eight physicians. After, this model goes into effect the goal is to have one pharmacist for every three physicians. Currently, the VA wants pharmacists to manage more patients with varying disease states, but there is not enough manpower to fulfill this request. If the VA follows through and implements this model it will have a huge impact on pharmacy because the VA is the largest healthcare system in the United States in terms of employees.
-Kevin Morris
WUSOP P1
I agree almost completely with Greg on this topic. I have seen first hand Pharmacists worried more about how many prescriptions they fill in a day as opposed to patient care. However, I don't believe it is the pharmacists fault totally, especialy pharmacists at chain stores such as Walgreens or CVS. The pharmacists are constatnly under pressure from corporate offices to get their numbers up. With that added stress, it's no wonder why patient care suffers.
As far as the article goes, I believe Patient-Centered Medical Home's are an excellent venue for a pharmacist truly dedicated to the welfare of the patient. I believe the team approach used in these homes provides the best care possible to the patients. As pharmacists, one of the things we strive for is that collaborative agreement with physicians and other medical professionals, and to be deemed useful. These homes are an excellent way to establish this connection if providing great patient care is what you are after.
Christine Atkinson- P1
I think that the idea of pharmacists playing a role in patient-centered medical homes is a step in the right direction for the profession. We would be expanding our role even further and we would be allowed to develop long-term relationships with our patients which is very important to me. We would also have access to past medical histories and everything we need in order to do comprehensive medication counseling with the patient (something doctors might not have time to do.) I believe the rewards of hiring a pharmacist in patient-centered medical homes far outweigh the costs and this is a perfect opportunity for pharmacists to step up to the plate for a new role.
I agree with my classmates who have said that pharmacists are not living up to their full potential, especially when the majority of pharmacists are being paid that type of money. My IPPE preceptor has told me stories about pharmacists that he knows that will stop working once they reach their "quota" for the day. I can't for the life of me understand how they are able to do that! How can they literally stand there and not do any work because they've done their 150 prescriptions for the day?! It's unbelievable and embarrassing.
In response to the article, it is refreshing to know that there are great opportunities out there like this for pharmacists to be more involved in patient care. This is definitely the direction I want to see pharmacy move toward. The team approach to patient care is something I am a huge fan of and look forward to learning more about it. I agree with the article saying pharmacists will have to show other healthcare providers what they can bring to the healthcare team and show the type of fundamental affect they can have on the Patient-Centered Medical Home.
Briana Rhyne P1
I also agree with previous posts that a medical-home, patient centered team based care approach is the way of the future of care. As more people live longer due to improved medical techniques and advancements, the number of people needing medical care will increase even more. A team based approach to help manage care will improve overall patient quality of life. Pharmacists will add an important aspect into the team based approach. Pharmacists have advance knowledge of medications, adverse drug reactions, and disease state managements.
Sendra P1
The article speaks about MTM and drug therapy plans that reduce medical cost and decrease drug errors. A pharmacist is capable of all of these things, but I feel like a lot of what a pharmacists can do isn't being utilize. They can do all of the things mentioned in the article extremely well, however they are so pushed by stores to fill a certain number of prescriptions instead of focusing on the patients. They currently play a small role in patient centered medical homes, but I feel as if that role could be expanded. Pharmacists have the knowledge, they are not able to use it. They are medication experts and should be the first line when picking a drug plan or therapy course. I think Patient Centered Medical Homes is where pharmacist can step up the pace and show healthcare what they can do.
- Nick Conley (P1)
Pharmacists can be a cheaper alternative to physicians, allowing patients to spend more time with health care professionals, which is strongly correlated with improved health outcomes. Also, the more a person can deal with specialist, ie a pharmacist who specializes in MTM, the more knowledge they can gain from the specialists deep knowledge of their subject area.
The major barrier to this as usual seems to be how to bill for this variety of care.
Tommy Carney - P1
Patient-centered medical homes will be an excellent place for pharmacists to practice medication therapy management. I believe it is a real challenge for pharmacists actually working in this new setting; however, I never expect it will take lots of time and effort to make it come true. This morning, Dr. Nurum told us that it took him 5 years to make the physicians at his building be willing to refer their patients to him. If his offering free service took 5 years to make the physicians to trust him totally, how possible for new pharmacists to find a paying job in a medical home in few months. Therefore, I do not think this ideal job will be popular in near future.
Tai Tran, P1
The Pharmacists role in medical homes is just another part of what could be a “well-oiled machine.” Every health-care disciple brings different views on a patient’s problem, and to have a pharmacist involved only creates better patient care. According to the article, “…we have to contribute uniquely to principles of the medical home.” The creation of team based clinics seem to be an obvious path for the future of health care. This way all of the patient’s information is collected and held in one place and any of the health-care providers in the clinic can access this information to optimize patient’s care. At the end of the day, optimizing patient’s care should be the goal of all health-care professionals and this kind of practice is what we should be focusing on, not turf battles.
Evan MacDonald P1
I agree with what Tyrsa had said about the reality of a pharmacy. The truth of the matter is that in order for pharmacists (in the community setting) to earn their +100K/year salary, it is largely dependent on the scripts that they sell and not on the counseling sessions that they provide for their patients/customers. Since pharmacists have to keep up with script volume, they are falling short with their patient care responsibilities.
The role that a pharmacist can play in a patient-centered medical home setting can be very valuable for both the patient and the professional. I just believe that at this time, the structure of chain pharmacies do not allow for the engagement of such a practice. The reimbursement issue and time limitations are also a barrier for pharmacists to have a more patient centered approach. I do believe that in order to achieve a successful model of MTM reimbursement, pharmacists must work closely with physician clinics.
Malia Y-P1
The Patient Centered Medical Home (PCMH) model consists of key roles pharmacists’ have in the healthcare system. This article, Medical Home 101, reiterates what pharmacists have been suggesting for the past couple of years. Working as a team is a crucial point towards a direction of success. This won’t take place unless primary care physicians are open-minded on the important roles pharmacists have as health care providers. Also, they should understand how pharmacists can make physicians’ practice of medicine be less hectic than it is now. As I mentioned a couple of weeks ago, I had encountered with a physician who was ignorant about the important roles of pharmacists in the health care system. He tried to tell me how minute pharmacists’ knowledge and tasks are compared to primary physicians. However studies show that collaborative work has shown a tremendous decrease in the number of visits to the emergency department, readmission to the hospital due to medication related issues, and the health care cost.
In addition, the last concept on this article about cultural changes is something I can defiantly relate to. For the past three years I have worked in a pharmacy where we have many patients from different cultural background. As Giuliano said, it’s crucial for pharmacists “to understand and embrace culture change.” Sometimes you look these patients and see how helpless they are and see how the language barrier prevents them from getting the help they need. Hence, it’s important for pharmacists to accept these kinds of situation and do the very best they can to help these patients. By providing a patient-centered care, pharmacists can demonstrate how valuable they are in the comprehensive primary care program.
F_Assefa
I think that pharmacist's participating in the patient-centered medical setting is important and a positive step for the profession. I understand that positive change towards something can take a long time to progress or change, and that's how it is for the pharmacy profession. At present, we are encouraging more pharmacists to participate in doing MTM's and immunizations etc. With this article and the medical home facilities, I think that pharmacists can really contribute a great deal in making sure that every patient id doing well with their drug therapies.
I worked with a pharmacist not too long ago and she used to go to long term care facilities to do chart reviews and talk to the people about their medicines. I have been with her to these reviews and I have seen the contributions a pharmacist can make in the health care team. Sometimes the people in charge of these small facilities do not really pay as much attention to the medicines the people take or they just re not knowledgeable enough. Either way, with the pharmacists putting their put forward and participating in the patient-centered care model, the patient is more likely to receive good healthcare over all.
The idea of adding a pharmacist to the health care team in a managed care facility is a great idea. What better way to monitor and adjust a patient’s medication regimen than by having a pharmacist available at all times. Our specialty is medication therapy; it SHOULD be the responsibility of the pharmacist to ensure that a patient is receiving the best possible care available. A medical home provides a wide variety of care to the patient and I absolutely agree that a pharmacist should be part of this environment.
~~Chrissi Tyrrell, P1
I completely agree with Tyrsa’s statement. Pharmacists can definitely play a major role in the patient centered medical home. Where physicians lack the time to consult with patients about their medication, the pharmacist could step in and offer their services. Like the article stated, pharmacists just have to get their foot in the door and prove their worth to the team. However, like Tyrsa was saying, the business aspect that has taken over pharmacies hinders the pharmacist from doing any type of work like this or MTM. The pharmacy is so focused on making money off of those additional prescriptions that pharmaceutical care and patient counseling get pushed to the side. Until pharmacy is freed from business, it will be difficult to expand our scope of practice and get involved in programs such as the patient centered medical home.
Allison Hoyle- P1
The beauty of the idea of the patient-centered medical home is each profession is able to provide a "piece of the pie" for the overall health of the patient. It focuses in on what the unique specialty is that each profession can offer, including the pharmacist being the medication expert. This also allows each profession to have TIME to offer what they need to do when everyone focuses on what they can bring to the table on behalf of the patient. My conclusions: GREAT idea, implement it ASAP, get people on board.
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