Linking the patient-centered medical home to community pharmacy via an innovative pharmacist care model.

ABSTRACT

OBJECTIVES: To develop and pilot test a model that extends pharmacists' direct patient care from the patient-centered medical home (PCMH) to the community pharmacy. SETTING: Two Michigan Medicine PCMH clinics and 2 CVS Pharmacy sites in Ann Arbor, MI. PRACTICE DESCRIPTION In the PCMH clinics, pharmacists have provided patient care using collaborative practice agreements for diabetes, hypertension, and hyperlipidemia for more than 5 years. PRACTICE INNOVATION Legal agreements were developed for sharing data and for accessing the Michigan Medicine Electronic Medical Record (EMR) in the CVS pharmacies. An immersion training model was used to train 2 community pharmacists to provide direct patient care and change medications to improve disease control. Then these community pharmacists provided disease management and comprehensive medication reviews (CMRs) in either the PCMH clinic or in CVS pharmacies. MAIN OUTCOME MEASURES: Glycosylated hemoglobin (A1C ≤ 9% and < 7%) and blood pressure (BP < 140/90) were compared for patients seen by PCMH pharmacists, patients seen by community pharmacists, and a propensity score-generated control group. Surveys were used to assess patient satisfaction. RESULTS: Of 503 shared patients, 200 received disease management and 113 received a CMR from the community pharmacists. Lack of efficacy was the most common reason for medication changes in diabetes (n = 136) and hypertension (n = 188). For CMR, optimizing the dosage regimen was the most common intervention. For the community pharmacist group, the odds of patients having an A1C ≤ 9% increased by 8% in each time period, whereas the odds decreased by 16% for the control group (odds ratio 1.29; P = 0.0028). No statistically significant differences were seen in the outcomes for patients seen by PCMH versus community pharmacists. Most patients (90%) rated the care as excellent. CONCLUSION: Direct patient care provided by community pharmacists, either in PCMH clinics or CVS pharmacies, was consistent with care provided by PCMH pharmacists. Patients were highly satisfied with the services provided.