Development and implementation of a collaboration between a patient-centered medical home and community pharmacy.

OBJECTIVES: This study aimed to describe the development and implementation strategies used in the collaboration between a patient-centered medical home (PCMH) and a grocery pharmacy chain and to evaluate the effectiveness of a community pharmacist's clinical integration in reducing hemoglobin A1c levels at clinic and patient levels. SETTING: The Kroger Co and Catholic Health Initiative St. Vincent. PRACTICE DESCRIPTION: The Kroger Co is a large grocery store that operates 27 pharmacies in the state of Arkansas, with 20 locations in the central Arkansas area. PCMH is part of a large health system in central Arkansas with 10 primary-care clinics in the area. PRACTICE INNOVATION: With the transition to value-based payment models, pharmacists are being utilized in settings outside of the pharmacy. This project demonstrates a partnership between a community pharmacy and PCMH. The community pharmacist spent 20 h/week in the PCMH providing medication therapy and disease state management services. Services were focused on patients with uncontrolled diabetes. EVALUATION: Descriptive statistics were used to describe the distribution of the pharmacists' time. A patient-level pre-post analysis of the mean changes in hemoglobin A1c (HbA1c) was conducted for patients who interacted directly with the pharmacist. A clinic-level analysis was conducted to evaluate changes in HbA1c compared to that in a nonequivalent control group using a standard quality measure. RESULTS: In total, 312 individual patients interacted with the pharmacist. Of those patients, 228 had diabetes. A total of 111 patients underwent pre-post HbA1c analysis. In those patients, there was a statistically significant reduction in mean HbA1c . There was no difference in clinic-level results between the intervention and control locations. CONCLUSION: Collaboration between a community pharmacy and PCMH is feasible and may improve patient care. Future research should include pharmacy-based visits and development of a process for improved communication.

Pharmacist-provided services and community pharmacist integration into a patient-centered medical home: A qualitative study of primary care clinic staff perceptions.

OBJECTIVES: To describe patient-centered medical home (PCMH) staff members' views toward community pharmacist involvement in patient care within the PCMH and to identify areas in which pharmacist-provided services can improve the quality of care in their clinics. DESIGN: Qualitative semistructured interview study. SETTING: One primary care clinic. PARTICIPANTS: Multidisciplinary clinic staff members. OUTCOME MEASURES: Views of staff toward implementing a community pharmacist into their clinic and top pharmacist services to help improve medication management within the clinic. RESULTS: A total of 14 staff members of the clinic participated in the study. Participants included physicians, clinical staff members such as registered nurse assistants, licensed practical nurses, and medical assistants, and clinic management. Key themes included the following: the clinic was open to implementing pharmacy services; the providers would be very receptive to pharmacist recommendations; the clinic is willing to try different pharmacist integration models to see what works best within the workflow; the pharmacist must be readily available for consultation; the pharmacist should hold an introductory meeting with the clinic; opinions vary on the best timing of pharmacist appointments with patients; and ideas vary about the best location for pharmacist consultations. The top 5 pharmacist services mentioned by participants included chronic condition management, medication reconciliation training, Beers List education, diabetes education, and adherence counseling. CONCLUSION: Primary care clinic staff support the integration of pharmacy services. Further research is needed to apply the results to other clinics and to identify barriers and opportunities in the implementation process.

Using an array of implementation strategies to improve success rates of pharmacist-initiated medication therapy management services in community pharmacies.

BACKGROUND: With the introduction of the Centers for Medicare and Medicaid Services Stars Measure program has come a greater expectation of Medication Therapy Management (MTM) services from community pharmacies. To meet the growing demand of these services, pharmacies have sought out various methods of engaging pharmacists to provide MTM. Barriers for completing MTM include inadequate time to complete the services, insufficient staffing, lack of sufficient compensation, billing difficulty, lack of interest among patients (including refusing MTM services when offered), inadequate training/experience, and lack of support from management. OBJECTIVE: To evaluate the impact of a financial incentive alone versus the incentive plus a package of individualized implementation strategies on the success rate of MTM services. METHODS: To increase MTM completion rates, The Kroger Company implemented a financial incentive for pharmacists in one of its market services areas. The following year the incentive was continued and an array of training and support strategies were implemented. The numbers of MTM claims and success rates for 2013 (no intervention), 2014 (financial incentive alone), and 2015 (incentive plus required training and ongoing support) were compared. RESULTS: A total of 7038 claims were extracted from 2013 to 2015. The number of completed claims had increased from 1385 in 2013 to 3265 in 2015. The total MTM success rates rose significantly from 42.9% in 2013 to 49.0% in 2014 (p = 0.001) and to 64.0% in 2015 (p < 0.001). CONCLUSIONS: A financial incentive plus a package of individualized implementation strategies increases success rates of MTM services compared to a financial incentive alone.