Even the best primary care physicians are on a tight schedule, which can sometimes make a routine appointment feel like a whirlwind experience for a patient.
When a doctor makes a diagnosis and prescribes a new medication, there often isn’t time to explain how the new medicine works and what side effects the patient may experience. So a doctor may often leave the exam room brimming with confidence, leaving behind a patient harboring uncertainties about whether they want or even need to take the new medication.
This lack of clear communication can lead to a disconnect between the doctor and patient, and that disconnect has the potential to lead to serious medical consequences.
According to Dr. David Moulton, director of quality for State of Franklin Healthcare Associates, a doctor who assumes his or her patients are taking their medications as prescribed has a 50-50 chance of being right.
“The assumption is correct 50 percent of the time, and you can’t predict which 50 percent are not going to take the medication,” Moulton said.
With that in mind, SoFHA has made the significant investment of adding clinical pharmacists to the team of professionals responsible for patient care. This was done with the goal of eliminating problems that can arise when patients either aren’t taking medications prescribed to them or taking those medications in an irregular manner.
In addition to a traditional four-year pharmacy program, clinical pharmacists have the added experience that comes with a two-year residency, which includes hands-on work with patients in a hospital or clinical setting. That valuable layer of training provides clinical pharmacists with a unique skill set that allows them to assess how medications are working and address concerns patients may have about a particular drug.
SoFHA brought its first clinical pharmacist on board in 2007 when Dr. Rick Hess began working with patients at Johnson City Internal Medicine Clinic, SoFHA’s largest adult clinic. Hess specializes in treating diabetes, which is prevalent in our area. Hess is Board Certified in Advanced Diabetes Management, a Certified Diabetes Educator, and Certified Insulin Pump Trainer.
At the time, SoFHA was in the process of establishing a culture that emphasized building teams to care for patients. Traditionally, patient care was a linear relationship between a patient, a nurse and a doctor. But SoFHA began to reimagine that model as one where several professionals with specialized areas of expertise were all able to feed useful information to the doctor, and Hess emerged as a very valuable spoke in a wheel that includes nurses, social workers, case managers and dieticians.
As the data began reflecting the positive impact Hess was having on patient care, demand for his services increased, and more clinical pharmacists were added to keep pace with that demand. At first, clinical pharmacists operated out of a nationally recognized diabetes clinic and focused primarily on managing that particular disease state.
But moving clinical pharmacists into a shared appointment model and allowing them to consult with patients about more general concerns about medications has paid huge dividends. Inserting a clinical pharmacist into a traditional doctor’s visit has helped fill a major gap that existed previously. While primary care physicians and nurses are forced to multitask, a clinical pharmacist can lock in on the medication piece of the puzzle and address problems and concerns that often go undetected if a clinical pharmacist is not involved in the process.
“When you put those three things together, you get what we call a shared medical visit where you really can start to understand their disease state, the medicines they’re taking, and, if they’re having problems, how to adjust the medicines,” Moulton said. “If you don’t have all those components, and they are having problems, how are you going to choose how to change their medical regimen and predict that they’re going to do well?”
Generally, a clinical pharmacist will meet with a patient for 15 to 20 minutes before the doctor comes into the exam room. When the doctor arrives, he or she will be armed with valuable information from the clinical pharmacist that paints a more complete picture of the patient’s current health.
“I would say 50 percent of the time they have found something of significance that leads to a more honest discussion with the patient,” Moulton said.
Predictably, this investment in clinical pharmacists has allowed SoFHA to stand out from the crowd when it comes to medication adherence, a crucial and demanding metric put in place by insurance providers. Last year SoFHA received 5 out of 5 stars from all three Medicare Advantage Plans for medication adherence for diabetes and hypertension medications and received two 5-star ratings and one 4-star rating for medication adherence for cholesterol medications.
SoFHA prides itself in developing, nurturing and refining a culture of preventative medicine and ownership of patient health, and this substantial investment in clinical pharmacists represents another substantial step forward for the provider group.