Role of the Pharmacist in the Patient-Centered Medical Home

Atlanta—In the patient-centered medical home (PCMH), patient services are provided through a consistent, coordinated relationship among the patient, the physician, and other members of the healthcare team, including the pharmacist. The PCMH model includes an accountability component designed to help ensure positive outcomes through continually provided appropriate levels of treatment. The role of the pharmacist is important in the PCMH, particularly in managing safe, cost-effective medication use. At a Contemporary Issues session at the AMCP meeting, Elaine Lei, PharmD, BCPS, CDE, clinical pharmacy specialist (CPS), Veterans Administration (VA) Long Beach Healthcare System, gave a presentation titled Integrating Pharmacy into the Patient-Centered Medical Home within the Community. She began her presentation by defining the core features of PCMHs, saying they “provide patients with a personal physician within a physician-directed medical practice that utilizes a whole-person orientation,” where care is coordinated and/or integrated; quality, safety, and access to care is enhanced; and payment reform is achieved. Dr. Lei continued by describing PACT (patient-aligned care team), a VA initiative introduced to all VA primary care sites in April 2010. Components of the PACT model include enhanced access (same-day appointments, increased shared medical appointments, and increased nonappointment care); care management and coordination (focus on high-risk patients); improved care for prevention and chronic disease; improved transitions of care between the PCMH and inpatient care and specialty care; and practice redesign to enhance communication and teamwork and improve processes of care. She then concentrated on the role of the CPS in the implementation of the PCMH model. The CPS is an integral part of the team, she said, particularly in management of chronic diseases (eg, hypertension, diabetes, hyperlipidemia, anticoagulation, hepatitis C, osteoporosis) as well as in areas of wellness and prevention (eg, smoking cessation counseling). The role of the CPS in optimizing patient access to care includes both scheduled and nonscheduled appointments with patients. At scheduled appointments, the CPS consults with the physician and the patient in managing chronic conditions; at nonscheduled, walk-in appointments, often referred by the primary care provider (PCP) or care manager, the CPS can meet with patients to discuss medication issues related to chronic diseases as well as provide wellness and prevention information. In the PACT program, patients had access to the CPS using a secure messaging system, to address issues related to medication, including questions about formulary status and concerns about specific medications prescribed by the PCP. The care coordination module of the program also involved the CPS in general patient education as well as specific wellness issues such as smoking cessation. Utilizing the care coordination component of the program also helped to identify high-risk patients; when routine PCP visits revealed issues such as low-density lipoprotein levels >100 in patients with ischemic heart disease or diabetes mellitus, HbA1c >90% in diabetes patients, or blood pressure >140/90, the data were entered in a clinical dashboard/patient registry alerting the CPS. The PCMH model utilized in the PACT program also improved transitions of care, with emphasis on polypharmacy reviews, and utilizing the CPS to assist traveling veterans in meeting their medication needs. Dr. Lei concluded her presentation by addressing some of the challenges still facing healthcare providers in the PACT program: optimizing the ratio of staff, increasing telephone care efficiency, improving communications among teams, triaging medication issues, and updating the patient registry/clinical dashboard.