OCEAN HEALTH INITIATIVES 2009 FQHC located in Ocean County, NJ Sites located in Toms River and Lakewood Mobile Van 18,866 Patients were served 8,100 Hi Risk Patients 2,481 Diabetic Patients 3,495 Hypertensive Patients

OCEAN HEALTH INITIATIVES M….Medication E…. Education D….Drug S…. Safety

M.E.D.S Team Members Theresa Berger, CEO Shira Meyer, MD Pranathi Mandadi, MD Jigna Desai, Pharmacist Rosemary Faughnan, RN Linda Whitfield-Spinner Kathleen Dagato, ANP Michelle Hutchinson, LPN Lynn Walker, LPN Israel Arroyo, Medical Assistant Ramdra Villanueva, Medical Assistant Kriscia Ramirez, Med Tech Hannah Maldony, RN DON Carmen Mallamaci, MD CMO

Partner Organizations Community Medical Center Provides Pharmacist New Jersey Primary Care Association Team Member; Provides Guidance and Resources Labcorp Provides discounted fees for uninsured patients

PSPC Aim Statement Implementation of Clinical Pharmacy Services for our highest risk Diabetic Patients who are experiencing Hypertension out of control Goals Improve Health Outcomes Improve Pharmacy Access Improve Patient Safety and Adherence

What are Clinical Pharmacy Services? Patient-centered services that promote the appropriate selection and utilization of medications to optimize individualized therapeutic outcomes Provided by an inter-disciplinary healthcare team through individualized patient assessment and management Services best provided by a pharmacist or by another healthcare professional in collaboration with a pharmacist

Clinical Pharmacy Services Elements Medication Access Services to Patients Patient Counseling Preventive Care Programs Drug Information Services to Patients Medication Reconciliation Services Provider Education Retrospective Drug Utilization Review Medication Therapy Management Disease State Management Prospective Chart Review and Provider Consultation

1. Medication Access Services to Patients Utilization of Drug Programs & Strategies (340B & Prime Vendor participation, partnerships with charitable & other outside payer groups, enrollment assistance for patients into programs that increase access such as Medicare part D or Medicaid, etc.) with the goal of obtaining a sustainable source of medications for patients that will improve access to care. Recommend generic alternative Patient Assistance Program

2. Patient Counseling Patient routinely interacts with a licensed health care provider when medication is picked up. Follow up phone call from nurse/ma/pharmacist

3. Preventive Care Programs Measure appropriate indicator (BMI, waist circumference, BP, health questionnaire, etc) and/or administer CLIA Waived test during individual or group screening encounters in order to identify and refer appropriate patient for evaluation and treatment. Administer or refer for immunization. A1C explained to patient BMI and/or Blood Pressure

4. Drug Information Services to Patients Written or verbal patient-friendly and culturally competent drug information provided to consumers. Patient Drug Information leaflets Disease State Pamphlets

5. Medication Reconciliation Services Identification of one accurate list of medications in combination with working directly with the patient or caregiver on their medications, recommendations and changes to therapy as appropriate, facilitation of communication of an accurate list of medications between patient, prescribers, and other health care professionals. Modified/updated current list Medication List given to patient OTC Meds included

6. Provider Education Deliver evidence-based medical information to providers that focuses on the place in therapy and adverse effects associated with the medication.

7. Retrospective Drug Utilization Review Periodic chart reviews in coordination with quality improvement for the purpose of evaluating organization performance in areas of medication prescribing and/or monitoring. Drug Utilization Reviews can be performed on patient profiles in dispensing and medical charts in primary care environments. Summary of evaluation is presented to clinical staff to support educational efforts, clinical program development as well as development of policies and procedures regarding medication use. DUR completed ADE’s identified and remedied

8. Medication Therapy Management Non-drug specific, non-disease specific and may include polypharmacy management, high risk / high alert medication management, and/or adherence/compliance education. MTM provider considers all medication related needs of the patient, not only those associated with a specific medical condition or therapeutic indication. May include utilization of collaborative practice agreements to create efficiency in patient management processes. Clinical Modifications made after DUR/ADE Recommendations given to patient or provider

9. Disease State Management Provision of medication-related assessment and education within defined medical conditions or therapeutic indications (i.e. anticoagulation). May include utilization of collaborative practice agreements to create efficiency in patient management processes. May include “group visits” that focus on patient evaluation and/or disease-focused education. Medication modification to obtain goals Labs ordered

10. Prospective Chart Review and Provider Consultation Prospective review of a patients medical chart for the purpose of providing recommendations to the prescribing practitioner regarding medication adjustments on the day of a medical encounter.

Pharmacist Role at Ocean Health Initiatives Consult with providers and nurses Assist in medication therapy What medication to add to regimen Most cost effective therapy Side effects/drug-interactions

How Clinical Pharmacy Benefits Patients Clinical Pharmacists are usually allotted more time to spend with the patients vs. their medical provider Increased Access to Care Better educated, more informed decision making Patient Centered Care Pharmacists are experts in medication safety Drug-drug interactions Drug-food interactions Drug-disease interactions

How Clinical Pharmacists Benefit Health Center Staff Provide up-to-date information New Guidelines New Medications News reports about medications Provide answers to patient questions before they are asked to medical staff

How Clinical Pharmacists Benefit Health Center Staff Chart review of difficult to manage patients Review patients not meeting goals Meets with provider and patient to improve patient’s understanding Spend more time educating patients/family Assists with chronic disease management

Results of the PSPC Patient Centered Care Integrated Team Approach to Care Evidence Based Practice Improved Staff and Patient Morale Better Patient Outcomes

Data Collection Demographics Demographics Age, gender, ethnicity Age, gender, ethnicity Health Insurance Health Insurance Medicare, Medicaid, None Medicare, Medicaid, None Baseline Health Status and lab tests Baseline Health Status and lab tests A1C, blood pressure, lipid levels, height, weight, BMI, co-morbid chronic conditions A1C, blood pressure, lipid levels, height, weight, BMI, co-morbid chronic conditions Follow up Health Status Markers Follow up Health Status Markers CPS Visits CPS Visits ADEs/pADEs ADEs/pADEs

M.E.D.S Data September 2009 April 2010 POF35 % Diabetics100% % B/P >130/80100% % HbA1C >925.7% Avg B/P153/95 Avg # Chr. Cond./Pt5 Avg # Medications6 % Patients E-Prescribe54% Avg BMI34.3 Avg HbA1C8.8 Average Age60 POF35 % Diabetics100% % B/P >130/8069% % HbA1C >98.6% Avg B/P143/84 Avg # Chr. Cond./Pt5 Avg # Medications6 % Patients E-Prescribe72% Avg BMI32.3 Avg HbA1C8.13 Average Age60

M.E.D.S Data

Clinical Pharmacy Services

Rate of pADEs and ADEs

Clinical Pharmacy Services Most Utilized at OHI Medication Access Services Patient Counseling and Follow up Phone Calls Preventive Care Program Provider Education Disease State Management

Accomplishments Obtained Hemoglobin A1C machine Prevents pADE/ADE Positive Reinforcement for Patients/Staff Medication Adjustments made in Real Time Improved Compliance Provided at low cost to uninsured patients Improved Patient Outcomes

Accomplishments Weekly team meetings for case management Improved Patient Outcomes Patient/Staff Awareness Family Centered Care Community Partners for Patient/Staff Education Revising EMR template to capture CPS Administrative and BOD Support

Case Presentation 52 year old male with h/o uncontrolled Diabetes and Hypertension began CPS 10/09. Services he received included: CPS Nutritional Counseling Enrolled in Medicaid Medication Management Patient Education DateBlood Pressure 10/20/09150/100 12/1/09140/98 2/24/10128/84

Challenges High number of patients are uninsured Many have more than one chronic medical condition Rise in medication cost and “polypharmacy” Providers are pressured to see more patients faster resulting in greater patient safety risk and lower patient satisfaction Maintain high quality of care within time restraints Data Collection Increase CPS Spread

OHI M.E.D.S Team