Determining Sustainable Strategies of Integrating Clinical Pharmacy Services into the Safety Net Clinical Team

Northwestern University’s School of Medicine has developed a pilot study to address unsafe medication use that results from difficulties in communication among health care professionals. The study incorporates pharmacy students and pharmacists into an interprofessional, coordinated approach using an affiliated Education Centered Medical Home (ECMH).  This is done either in-person or remotely using telephones and electronic health records (EHR) depending on the most effective solution for the setting based on patients achieving control of their chronic conditions, pharmacy students reaching curriculum goals, and practices demonstrating sustainability. This approach allows for collaboration between health professionals through safety briefings or “team huddles” and was originally devised by the Institute for Healthcare Improvement.  Such operational briefings offer opportunities to communicate across the primary care team (composed of physicians, residents, nurses, pharmacists, and medical and pharmacy students) about medication safety issues, health care goals, and reviews of aggregate patient safety data. 

In this descriptive, quality improvement pilot study, members of the care team at PCC Austin Family Health Center and Norwegian American Hospital will select a small set (approximately 75) of patients from the ECMH patient panel who meet the inclusion criteria. Clinical pharmacists and/or pharmacy students will provide integrated clinical pharmacy services by joining the regular care team either in person or via remote chart access through Alliance EHR.  The pharmacy team initiates the medication reconciliation process while simultaneously screening for preventable adverse drug events (pADEs), counsels the patient, and coordinates access as needed using existing tools as part of standards of care.  The pharmacy team contributes to pre-clinic session team huddles through which the patient list is reviewed by the primary care team and pADEs and the status of goals of care is identified. Twice a month, feedback sessions are held (concurrent with the team huddle) at which time the pharmacy team reviews aggregate safety and outcome data abstracted from the site’s EHR in the form of a dashboard. 

De-identified clinical markers are recorded at baseline every 3 months thereafter for up to 30 months as long as the patient is receiving care from the pharmacy team. Clinical markers include hemoglobin A1c, blood pressure, LDL, PT-INR, Adverse Drug Events,  hospitalizations, prevalence and type drug-related problems (DRPs) associated with pADEs , and number of emergency room visits.  These clinical markers are followed to determine when patients reach goal or a controlled status as defined by existing national guidelines according to the National Guideline Clearinghouse. 

The educational benefit for pharmacy students who take part in the clinical care team is assessed based on each school’s curricular goals, which could include educational outcomes on traditional exams or other clinical education outcomes.  Sustainability of the types of integration of clinical pharmacy services into the care team is assessed based on formation of partnerships between PCC Austin ECMH , Norwegian American Hospital, and each pharmacy school, the non-volunteer presence of pharmacy students and faculty in the clinic, and the interaction of the pharmacy team with patients. 

Implementation of the intervention includes Plan-Do-Study-Act (PDSA) and quality improvement evaluations to assess effectiveness and economic sustainability, which is used to adjust and improve the execution and possible expansion of the intervention for other local ECMHs in the future.  All procedures performed are for diagnostic and treatment purposes as part of the standard of care.  If these quality improvement measures demonstrate sustainabillity in getting patients to goal while forming meaningful partnerships with local pharmacy schools, then it is hoped that this method will expand to other local ECMHs in future studies.