Factors necessary for a community pharmacist to achieve interprofessional collaboration in home-based care in Japan

AIM

Interprofessional collaboration between medical professionals is an essential aspect of caring for Japan's super-aging population, but studies on the subject have been geographically limited in scope. Therefore, we aimed to determine the factors necessary for pharmacists to achieve interprofessional collaboration in home-based care in Japan.

METHODS

Our online questionnaire survey was conducted from February 1, 2023 to February 15, 2023. The Japan Pharmaceutical Association introduced this survey to their membership, and survey letters were sent to hospitals and community pharmacies that were not included in this association.

RESULTS

The study involved 1156 and 36 participants working in a community pharmacy and a hospital, respectively. These participants were divided into the collaboration group and the non-collaboration group. Enough time for visiting patients and for preparing the first visiting plan was important to achieve interprofessional collaboration in home-based care for a hospital pharmacist. More than 5 years of experience working in home-based care and participation in pre-visit conferences, discharge conferences, meetings with persons in charge of services were independent factors in collaborating with other medical staff for a community pharmacist.

CONCLUSION

Hospital pharmacists with enough time to prepare and visit for home-based care and community pharmacists working in home-based care for more than 5 years and who share information on home-based care with medical staff achieved interprofessional collaboration in home-based care. Geriatr Gerontol Int 2024; ••: ••-••.

Comprehensive Medication Management Services with a Holistic Point of View, a Scoping Review

Implementing Comprehensive Medication Management (CMM) services uncovered the importance of the totality of the patient's perspective in this process. The holistic approach takes into account the physical, mental and emotional well-being of individuals, as well as their socioeconomic circumstances. The aim of this study was to characterize the scientific evidence associated with CMM services that included this holistic approach. A scoping review was conducted based on Arksey and O'Malley's method. Searches were performed in Google Scholar for papers published between 2010 and 2020 in English, Spanish and Portuguese. Study design, health contexts, sample of patients, results obtained, barriers and facilitators, and the integration of a holistic approach were determined. Two hundred and eighteen papers were evaluated, most of which focused on the implementation of this service through prospective observational studies. A minority of studies reported on a holistic approach, a smaller number examined the effect of social determinants of health, the patient's medication experiences and the pharmacotherapy outcomes from the patient's perspective. Despite the progress achieved, most of the referents do not yet reflect a broader view of the patient's life situation and its relationship to pharmacotherapy and the ways in which the pharmacist implements holistic elements to solve or prevent drug-related problems.

Return-On-Investment for Billable Pharmacist-Provided Services in the Primary Care Setting

BACKGROUND

Pharmacists are increasingly fulfilling roles on primary care teams, yet business models for pharmacist services in these settings have not been optimized. This study describes how an ambulatory care pharmacy department implemented various billing methods to generate revenue for pharmacist services.

OBJECTIVES

(1) Describe pharmacist-delivered billable and non-billable services; and (2) Assess the impact of various billing methods on the return-on-investment (ROI) for billable services.

METHODS

This study was conducted from September 2016 to August 2017 in Virginia. Pharmacist time spent performing billable encounters using current procedural technology (CPT) codes (e.g., incident-to a physician, annual wellness visits) was calculated. Encounters eligible for the hospital-based facility (G0463) and chronic care management (CCM) codes were considered to be potentially billable services. The ROI was calculated for billable and potentially billable services.

RESULTS

A total of 948.3 hours (0.46 full-time equivalents (FTE)), 17% of all clinical services, were billed using CPT codes. This resulted in a total revenue of $173,638.66. Missed revenue from not billing for the G0463 and CCM codes was $68,268.37. The cost of pharmacist services for 0.46 FTE was $78,613.08, resulting in a ROI for billed pharmacist services of 1.2:1. The ROI increased to 1.6:1 when considering potentially billable services.

CONCLUSION

It is feasible to have a positive ROI for billable pharmacist services. To achieve a sustainable business model, there must be a high volume of billable services. G0463 and CCM codes are often underutilized, yet represent significant opportunities in revenue for pharmacist services and should be pursued.

Pharmacist-Led Annual Wellness Visits: A Review

Objective:

To summarize findings of pharmacist involvement with Medicare Annual Wellness Visits (AWV), including the number of pharmacist interventions, patient/provider satisfaction, and billing models.

Data Sources:

A literature search was conducted using PubMed, ScienceDirect College Edition Journals Collection-Health and Life Sciences, Cochrane Library, CINAHL, Medline, and Academic Search Complete, including dates between January 01, 2011, and November 05, 2018.

Study Selection:

Search was limited to full-text, peer-reviewed articles, published in English which were relevant based on identification of a pharmacist’s role in AWV. Search terms included “Medicare annual wellness visits” and “Pharmacists.”

Data Extraction:

A data extraction tool was used to collect study authors, year published, study design, description of intervention, objectives, primary outcome measures, model of care, clinic setting, location, results, number of patients, and overall effect.

Results:

Of the 139 returned citations, 11 met inclusion criteria. Of the practice settings, 7 (72.72%) utilized a collaborative practice agreement for conducting AWV. Six (54.54%) of the studies measured financial outcomes, 3 (27.27%) measured satisfaction of students/patients/physicians, 2 (18.18%) measured clinical outcomes, and finally 4 (36.36%) measured number and types of interventions. Review revealed that 6 (54.54%) articles had more medication-related interventions than nonmedication-related interventions. Studies evaluating finances as it relates to AWVs had various findings including 38% return on investment, higher reimbursement for pharmacist-led visits, and an increase in revenue.

Conclusion:

In a variety of outpatient health centers, AWV were conducted by pharmacists, had a positive impact on patient care, and had high satisfaction rates between patients and physicians.

Applying Contemporary Management Principles to Implementing and Evaluating Value-Added Pharmacist Services

Value-added pharmacy services encompass traditional and emerging services provided by pharmacists to individual and entire populations of persons increasingly under the auspices of a public health mandate. The success of value-added pharmacy services is enhanced when they are carried out and assessed using appropriate theory-based paradigms. Many of the more important management theories for pharmacy services consider the “servicescape” of these services recognizing the uniqueness of each patient and service encounter that vary based upon health needs and myriad other factors. In addition, implementation science principles help ensure the financial viability and sustainability of these services. This commentary reviews some of the foundational management theories and provides a number of examples of these theories that have been applied successfully resulting in a greater prevalence and scope of value-added services being offered.

Linking the patient-centered medical home to community pharmacy via an innovative pharmacist care model

OBJECTIVES

To develop and pilot test a model that extends pharmacists' direct patient care from the patient-centered medical home (PCMH) to the community pharmacy.

SETTING

Two Michigan Medicine PCMH clinics and 2 CVS Pharmacy sites in Ann Arbor, MI.

PRACTICE DESCRIPTION

In the PCMH clinics, pharmacists have provided patient care using collaborative practice agreements for diabetes, hypertension, and hyperlipidemia for more than 5 years.

PRACTICE INNOVATION

Legal agreements were developed for sharing data and for accessing the Michigan Medicine Electronic Medical Record (EMR) in the CVS pharmacies. An immersion training model was used to train 2 community pharmacists to provide direct patient care and change medications to improve disease control. Then these community pharmacists provided disease management and comprehensive medication reviews (CMRs) in either the PCMH clinic or in CVS pharmacies.

MAIN OUTCOME MEASURES

Glycosylated hemoglobin (A1C ≤ 9% and < 7%) and blood pressure (BP < 140/90) were compared for patients seen by PCMH pharmacists, patients seen by community pharmacists, and a propensity score-generated control group. Surveys were used to assess patient satisfaction.

RESULTS

Of 503 shared patients, 200 received disease management and 113 received a CMR from the community pharmacists. Lack of efficacy was the most common reason for medication changes in diabetes (n = 136) and hypertension (n = 188). For CMR, optimizing the dosage regimen was the most common intervention. For the community pharmacist group, the odds of patients having an A1C ≤ 9% increased by 8% in each time period, whereas the odds decreased by 16% for the control group (odds ratio 1.29; P = 0.0028). No statistically significant differences were seen in the outcomes for patients seen by PCMH versus community pharmacists. Most patients (90%) rated the care as excellent.

CONCLUSION

Direct patient care provided by community pharmacists, either in PCMH clinics or CVS pharmacies, was consistent with care provided by PCMH pharmacists. Patients were highly satisfied with the services provided.

Clinical pharmacists in primary care: Provider satisfaction and perceived impact on quality of care provided

PURPOSE

The purpose of this study is to evaluate primary care provider satisfaction and perceived impact of clinical pharmacy services on the disease state management in primary care.

METHODS

A cross-sectional survey with 24 items and 4 domains was distributed anonymously to pharmacy residency program directors across the United States who were requested to forward the survey to their primary care provider colleagues. Primary care providers were asked to complete the survey.

RESULTS

A total of 144 primary care providers responded to the survey, with 130 reporting a clinical pharmacist within their primary care practice and 114 completing the entire survey. Primary care providers report pharmacists positively impact quality of care (mean = 5.5 on Likert scale of 1-6; standard deviation = 0.72), high satisfaction with pharmacy services provided (5.5; standard deviation = 0.79), and no increase in workload as a result of clinical pharmacists (5.5; standard deviation = 0.77). Primary care providers would recommend clinical pharmacists to other primary care practices (5.7; standard deviation = 0.59). Primary care providers perceived specific types of pharmacy services to have the greatest impact on patient care: medication therapy management (38.6%), disease-focused management (29.82%), and medication reconciliation (11.4%). Primary care providers indicated the most valuable disease-focused pharmacy services as diabetes (58.78%), hypertension (9.65%), and pain (11.4%).

CONCLUSION

Primary care providers report high satisfaction with and perceived benefit of clinical pharmacy services in primary care and viewed medication therapy management and disease-focused management of diabetes, hypertension, and pain as the most valuable clinical pharmacy services. These results can be used to inform development or expansion of clinical pharmacy services in primary care.