Pharmacists in Federally Qualified Health Centers: Models of Care to Improve Chronic Disease

Jennifer L. Rodis, PharmD, BCPS, FAPhA; Traci R. Capesius, MPH; Julie T. Rainey, BA; Magdi H. Awad, PharmD; Carrie Hornbeck Fox, MPH

Disclosures

Prev Chronic Dis. 2019;16(11):e153 

In This Article

Abstract and Introduction

Abstract

Introduction: Pharmacists are underused in the care of chronic disease. The primary objectives of this project were to 1) describe the factors that influence initiation of and sustainability for pharmacist-provided medication therapy management (MTM) in federally qualified health centers (FQHCs), with secondary objectives to report the number of patients receiving MTM by a pharmacist who achieve 2) hemoglobin A1c (HbA1c) control (≤9%) and 3) blood pressure control (<140/90 mm Hg).

Methods: We evaluated MTM provided by pharmacists in 10 FQHCs in Ohio through qualitative thematic analysis of semi-structured interviews with pharmacists and FQHC leadership and aggregate reporting of clinical markers.

Results: Facilitators of MTM included relationship building with clinicians, staff, and patients; regular verbal or electronic communication with care team members; and alignment with quality goals. Common MTM model elements included MTM provided distinct from dispensing medications, clinician referrals, and electronic health record access. Financial compensation strategies were inadequate and varied; they included 340B revenue, incident-to billing, grants, and shared positions with academic institutions. Of 1,692 enrolled patients, 60% (n = 693 of 1,153) achieved HbA1c ≤9%, and 79% (n = 758 of 959) achieved blood pressure <140/90 mm Hg.

Conclusion: Through this statewide collaborative, access for patients in FQHCs to MTM by pharmacists increased. The factors we identified that facilitate MTM practice models can be used to enhance the models to achieve clinical goals. Collaboration among clinic staff and community partners can improve models of care and improve chronic disease outcomes.

Introduction

Although well positioned to fill gaps in health care, pharmacists have long been underused.[1,2] This is especially relevant in chronic disease management despite evidence that demonstrates pharmacists' success in improving outcomes through collaborative care and medication therapy management (MTM).[1–6] MTM involves a multifaceted approach of reviewing medications, identifying and remedying medication-related problems, providing disease state management and self-management education, addressing medication adherence issues, and considering preventive health strategies to optimize medication-related health.[3,4,7,8] An MTM service includes a comprehensive medication review to ensure that the patient's medication-related needs have been met and all of their medications are appropriate, effective, safe, and convenient. At the end of the visit, a care plan is developed and shared with the patient and the primary care provider to resolve and prevent any drug therapy problems by eliminating unnecessary medications, initiating appropriate medications, adjusting dosage regimens, addressing adverse reactions, and increasing the patient's willingness and ability to adhere to the medication regimen.[9,10] Through MTM, pharmacists play an important role in addressing health care disparities in underserved areas.[11–14] Developments including passage of the Patient Protection and Affordable Care Act,[15] subsequent expansion of Medicaid, and the establishment of federally qualified health centers (FQHCs) have created more opportunities for pharmacists to provide care in community-based settings. Integration of MTM remains limited in many community-based settings due to lack of reimbursement, medical provider buy-in, time, and resources.[16,17] Additionally, evidence is sparse with regard to outcomes in FQHCs and factors that facilitate initiation, continuation, and sustainability of care provided by pharmacists in FQHCs.[17,18]

The Ohio Department of Health (ODH), Ohio Pharmacists Association (OPA), and Ohio Association of Community Health Centers (OACHC) collaborated with colleges of pharmacy in Ohio on a 5-year, 2-phase project to address these gaps and opportunities. This project involved developing a statewide learning community and advisory board, tracking aggregate outcomes for patients receiving care from pharmacists, and qualitatively evaluating processes surrounding pharmacist-provided MTM. The primary objectives of this project were to 1) describe factors that influence initiation of and sustainability for pharmacist-provided MTM in FQHCs, and 2) report the number of patients receiving MTM by a pharmacist who achieved hemoglobin A1c (HbA1c) control (≤9%) and blood pressure control (<140/90 mm Hg).

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