A pharmacist's contribution within a patient-centered medical home

Abstract

ObjectivesTo evaluate the impact of a pharmacist embedded in a primary care physician (PCP) group practice to assist in achieving patient-centered medical home (PCMH) accreditation by increasing chronic care measures through the use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) medications in patients with concomitant diabetes mellitus (DM) and hypertension (HTN). SettingPCP practice in Pittsburgh, PA. Practice description16 decentralized PCPs linked by electronic health record system. Practice innovationAn academically based pharmacist provided medication management services to the PCP group for patients with DM and HTN using criteria developed by the quality committee of the practice. InterventionsUsing the electronic health records and inclusion criteria, a list of patients with concomitant DM and HTN and not currently taking ACEI or ARB medications was obtained. Patients were excluded based on predetermined criteria. Electronic messages were sent to PCPs responsible for the remaining patients. ResultsAcross the 16 participating office locations, 5,258 patients were diagnosed with DM and HTN. Of these, 4,304 were already being treated with an ACEI or ARB medication (81.9%). Of the remaining 954 patients, the pharmacist determined that 784 met at least one of the exclusion criteria (82.2%). Recommendations were sent for the remaining 170 patients, and the pharmacist received 150 responses (88.2%). Physicians agreed with the recommendation to initiate therapy in 82 patients (54.7%), and therapy was started in 56 of those patients (68.3%). ConclusionThis project showed the positive effect of a pharmacist in helping a PCP group address quality projects relating to PCMH accreditation and improvements in care that can affect Medicare star ratings.