Physicians refer patients to MTM pharmacists at Fairview

Abstract

Molly Ekstrand, BSPharm, counseled several patients who were referred to her through the primary care clinic at Fairview Health Services in Minneapolis, where she worked as a medication therapy management (MTM) pharmacist.She remembers one instance in particular. The patient was in her late 40s and on a complex medication regimen, mainly due to pyelonephritis. She didn’t want to take her medications because of the adverse effects. The regimen was also complex and hard to follow because of dosing.Ekstrand had some suggestions for optimizing the patient’s drug therapy that could be helpful for the patient’s nephrologist, Rajiv Shah, MD, to know about.“I faxed the letter to the clinic, and that started my working relationship with Dr. Shah,” Ekstrand, who now works as an MTM pharmacist at Park Nicollet Health Services, told Pharmacy Today.‘Support system for patients’Shah was grateful Ekstrand could help his patient better understand her medications and the value of them.“When physicians have experience with MTM pharmacists, they realize it’s not about us being the prescriber police,” said Ekstrand. “It’s really a support system for patients. And if you can help patients manage their medications, we are giving patients the confidence to manage their health and overall well-being.”Although Shah has always been an advocate for pharmacists—especially as a nephrologist who deals with complex medication dosing and intensive regimens for kidney disease and transplant patients—he hadn’t realized until Ekstrand faxed the letter over that an MTM service existed in the outpatient setting.“When you think about what patients can do to impact their care, it’s a healthy lifestyle but also taking the medications they are prescribed,” Shah told Today. “No one can force patients to take their pills, but if you empower them and educate them about why it’s important, that’s huge.”Shah and Ekstrand first made contact more than 5 years ago. Now Shah regularly refers his patients to the MTM pharmacists at Fairview.Integrated health systemFairview is an integrated health system with MTM pharmacists embedded in 30 primary health care clinics through-out Minnesota. Many specialists they work with, like Shah, are outside of the system. Shah is technically affiliated with Fairview, however, and the primary care clinic where Ekstrand worked was in close proximity to Shah’s nephrology practice.Ekstrand did not have a collaborative practice agreement with Shah, but she did with the primary care providers in the clinic at Fairview.Referrals to Fairview’s pharmacy MTM services don’t always come through a patient’s primary care provider, however.“We have worked with specialists’ patients in cases where we haven’t worked with their primary care physician,” Amanda Brummel, PharmD, director of clinical ambulatory pharmacy services at Fairview Pharmacy Services, told Today.She said they work with many cardiologists as well who refer their patients.MORE ONLINE•Tedx talk by Rajiv Shah, MD: www.youtube.com/watch? v=ajmT93H2RpA&safe=activeThe handoffShah refers patients to MTM pharmacists directly or through the patient’s primary care provider.“I might talk to the primary care provider or the patient and say there’s this service—and they will spend an hour with you initially to go over everything. And it’s something that we as physicians can’t do,” said Shah, who has also advocated publicly for the profession of pharmacy and recently spoke about pharmacists as the new “disrupters” in health care during a Tedx talk.Shah refers patients to MTM pharmacists directly or through the patient’s primary care provider.Fairview MTM pharmacists see patients in an exam room, just like any other clinic appointment.“It’s a little abstract at first for patients, so that’s where the trust and warm transfer can help,” said Brummel.After Shah makes the referral and the patient sees the pharmacist, the MTM pharmacist faxes over a copy of the notes from the visit, and they communicate any questions by phone. Shah cannot access Fairview’s electronic medical record system since he is not directly part of the system.Brummel said the positive experiences and the difference that physicians see in their patients makes them want to continue referring patients to MTM services.“I truly believe the main driver to this is the success that the pharmacist has had as part of the team and helping the patient,” she said. Molly Ekstrand, BSPharm, counseled several patients who were referred to her through the primary care clinic at Fairview Health Services in Minneapolis, where she worked as a medication therapy management (MTM) pharmacist. She remembers one instance in particular. The patient was in her late 40s and on a complex medication regimen, mainly due to pyelonephritis. She didn’t want to take her medications because of the adverse effects. The regimen was also complex and hard to follow because of dosing. Ekstrand had some suggestions for optimizing the patient’s drug therapy that could be helpful for the patient’s nephrologist, Rajiv Shah, MD, to know about. “I faxed the letter to the clinic, and that started my working relationship with Dr. Shah,” Ekstrand, who now works as an MTM pharmacist at Park Nicollet Health Services, told Pharmacy Today. ‘Support system for patients’Shah was grateful Ekstrand could help his patient better understand her medications and the value of them.“When physicians have experience with MTM pharmacists, they realize it’s not about us being the prescriber police,” said Ekstrand. “It’s really a support system for patients. And if you can help patients manage their medications, we are giving patients the confidence to manage their health and overall well-being.”Although Shah has always been an advocate for pharmacists—especially as a nephrologist who deals with complex medication dosing and intensive regimens for kidney disease and transplant patients—he hadn’t realized until Ekstrand faxed the letter over that an MTM service existed in the outpatient setting.“When you think about what patients can do to impact their care, it’s a healthy lifestyle but also taking the medications they are prescribed,” Shah told Today. “No one can force patients to take their pills, but if you empower them and educate them about why it’s important, that’s huge.”Shah and Ekstrand first made contact more than 5 years ago. Now Shah regularly refers his patients to the MTM pharmacists at Fairview. Shah was grateful Ekstrand could help his patient better understand her medications and the value of them. “When physicians have experience with MTM pharmacists, they realize it’s not about us being the prescriber police,” said Ekstrand. “It’s really a support system for patients. And if you can help patients manage their medications, we are giving patients the confidence to manage their health and overall well-being.” Although Shah has always been an advocate for pharmacists—especially as a nephrologist who deals with complex medication dosing and intensive regimens for kidney disease and transplant patients—he hadn’t realized until Ekstrand faxed the letter over that an MTM service existed in the outpatient setting. “When you think about what patients can do to impact their care, it’s a healthy lifestyle but also taking the medications they are prescribed,” Shah told Today. “No one can force patients to take their pills, but if you empower them and educate them about why it’s important, that’s huge.” Shah and Ekstrand first made contact more than 5 years ago. Now Shah regularly refers his patients to the MTM pharmacists at Fairview. Integrated health systemFairview is an integrated health system with MTM pharmacists embedded in 30 primary health care clinics through-out Minnesota. Many specialists they work with, like Shah, are outside of the system. Shah is technically affiliated with Fairview, however, and the primary care clinic where Ekstrand worked was in close proximity to Shah’s nephrology practice.Ekstrand did not have a collaborative practice agreement with Shah, but she did with the primary care providers in the clinic at Fairview.Referrals to Fairview’s pharmacy MTM services don’t always come through a patient’s primary care provider, however.“We have worked with specialists’ patients in cases where we haven’t worked with their primary care physician,” Amanda Brummel, PharmD, director of clinical ambulatory pharmacy services at Fairview Pharmacy Services, told Today.She said they work with many cardiologists as well who refer their patients.MORE ONLINE•Tedx talk by Rajiv Shah, MD: www.youtube.com/watch? v=ajmT93H2RpA&safe=active Fairview is an integrated health system with MTM pharmacists embedded in 30 primary health care clinics through-out Minnesota. Many specialists they work with, like Shah, are outside of the system. Shah is technically affiliated with Fairview, however, and the primary care clinic where Ekstrand worked was in close proximity to Shah’s nephrology practice. Ekstrand did not have a collaborative practice agreement with Shah, but she did with the primary care providers in the clinic at Fairview. Referrals to Fairview’s pharmacy MTM services don’t always come through a patient’s primary care provider, however. “We have worked with specialists’ patients in cases where we haven’t worked with their primary care physician,” Amanda Brummel, PharmD, director of clinical ambulatory pharmacy services at Fairview Pharmacy Services, told Today. She said they work with many cardiologists as well who refer their patients. MORE ONLINE•Tedx talk by Rajiv Shah, MD: www.youtube.com/watch? v=ajmT93H2RpA&safe=active MORE ONLINE•Tedx talk by Rajiv Shah, MD: www.youtube.com/watch? v=ajmT93H2RpA&safe=active MORE ONLINE•Tedx talk by Rajiv Shah, MD: www.youtube.com/watch? v=ajmT93H2RpA&safe=active •Tedx talk by Rajiv Shah, MD: www.youtube.com/watch? v=ajmT93H2RpA&safe=active The handoffShah refers patients to MTM pharmacists directly or through the patient’s primary care provider.“I might talk to the primary care provider or the patient and say there’s this service—and they will spend an hour with you initially to go over everything. And it’s something that we as physicians can’t do,” said Shah, who has also advocated publicly for the profession of pharmacy and recently spoke about pharmacists as the new “disrupters” in health care during a Tedx talk.Shah refers patients to MTM pharmacists directly or through the patient’s primary care provider.Fairview MTM pharmacists see patients in an exam room, just like any other clinic appointment.“It’s a little abstract at first for patients, so that’s where the trust and warm transfer can help,” said Brummel.After Shah makes the referral and the patient sees the pharmacist, the MTM pharmacist faxes over a copy of the notes from the visit, and they communicate any questions by phone. Shah cannot access Fairview’s electronic medical record system since he is not directly part of the system.Brummel said the positive experiences and the difference that physicians see in their patients makes them want to continue referring patients to MTM services.“I truly believe the main driver to this is the success that the pharmacist has had as part of the team and helping the patient,” she said. Shah refers patients to MTM pharmacists directly or through the patient’s primary care provider. “I might talk to the primary care provider or the patient and say there’s this service—and they will spend an hour with you initially to go over everything. And it’s something that we as physicians can’t do,” said Shah, who has also advocated publicly for the profession of pharmacy and recently spoke about pharmacists as the new “disrupters” in health care during a Tedx talk.Shah refers patients to MTM pharmacists directly or through the patient’s primary care provider. Fairview MTM pharmacists see patients in an exam room, just like any other clinic appointment. “It’s a little abstract at first for patients, so that’s where the trust and warm transfer can help,” said Brummel. After Shah makes the referral and the patient sees the pharmacist, the MTM pharmacist faxes over a copy of the notes from the visit, and they communicate any questions by phone. Shah cannot access Fairview’s electronic medical record system since he is not directly part of the system. Brummel said the positive experiences and the difference that physicians see in their patients makes them want to continue referring patients to MTM services. “I truly believe the main driver to this is the success that the pharmacist has had as part of the team and helping the patient,” she said.