The NGA released an issue brief on January 2015, titled “The Expanding Role of Pharma- cists in a Transformed Health Care System.” The report acknowl- edges that the scope of practice as allowed by state laws restrict pharmacist from serv- ing at the full extent of their training and license and encourages states and private entities to maximize phar- macy services by classifying them as health care providers with the state insurance code, state employee health plans, health infor- mation exchanges, and Medicaid. LEFT: A visual representaon of an Accountable Care Organizaon (ACO), a form of team-based care. This model is paent-centered, requires collaboraon between health care professionals, requires common access to electronic health records, and alignment of payment to outcomes. Image adapted from: hp://www.healthteamworks.org/medical- neighborhood/aco.html Sodium-glucose co- transporter 2 (SGLT2) is ex- pressed in the proximal renal tubule and responsible for reabsorption of the majority of glucose filtered by the kidneys. The FDA approved two new drugs in the SGLT2-inhibitor class of anti-diabetic drugs, dapagliflozin (Farxiga®) and empagliflozin (Jardiance®), which possess distinct ad- vantages over canagliflozin (Invokana®). Specifically, both can be used in patients with severe hepatic impair- ment. Jardiance® has the additional advantage of less restrictive use in patients with impaired renal function and no association of use with inci- dence of bladder cancer. A recent controversy has arisen from manufacturer ads tout- ing its weight-loss and blood pressure reduction “claims” as benefits for use outside its approved indication. H.R.4190, a bill presented to the 113 th Con- gress in 2014 to amend title XVIII (Medicare) of the Social Security Act to cover pharmacist services, died in committee with 123 co- sponsors. However, the effort has gained mo- mentum and has been re-introduced under H.R.592/S.314, both titled “Pharmacy and Medically Underserved Areas Enhancement Act” in January to the 114 th Congress. With all previous co-sponsors having been re-elected in this past midterm cycle, H.R.592 and S.314 have gained 83 and 10 sponsors as of April 2015, respectively. “Health care experts increasingly agree that including pharmacists on chronic care delivery teams can im- prove care and reduce the costs of treating chronic illnesses”
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Transcript
The NGA released an issue brief on January
2015, titled “The Expanding Role of Pharma-
cists in a Transformed
Health Care System.”
The report acknowl-
edges that the scope of
practice as allowed by
state laws restrict
pharmacist from serv-
ing at the full extent of
their training and license and encourages
states and private entities to maximize phar-
macy services by classifying them as health
care providers with the state insurance code,
state employee health plans, health infor-
mation exchanges, and Medicaid.
LEFT: A visual representation of an Accountable Care Organization (ACO), a form of team-based
care. This model is patient-centered, requires collaboration between health care professionals,
requires common access to electronic health records, and alignment of payment to outcomes.
upfront investment in pharmacy services led to in-
creased revenue and physician productivity for an
ROI of 3:1. With the addition of quality indicated by
cost avoidance through better chronic disease man-
agement, the ROI is 15:1.
A 2015 systematic review and meta-analysis evaluat-
ing Medication Therapy Management (MTM) ser-
vices on medication-related problems, morbidity,
mortality, quality of life, and health care use, costs,
and harms found wide heterogeneity in populations
and interventions, and inadequate control of con-
founding that precluded an assessment of the out-
comes of interest. Despite this heterogeneity, the
authors found improved medication adherence, med-
ication appropriateness, and medication dosing. A
body of evidence indicates that pharmacists can im-
pact quality metrics while working as part of a mem-
ber of the health care team. As healthcare reimburse-
ment schemes continue to shift from volume-based
models towards quality-based outcomes, the value of
pharmacy grows and the argument to integrate phar-
macy services becomes more compelling. It is im-
portant, however, that these services continue to offer
the “highest quality at the lowest cost.”
1305/1422 Grantee-
Related Poster Sessions
Medication Therapy Management (MTM) in Federally Qualified Health Centers (FQHC): Improving Chronic Disease Outcomes
From March 2014-February 2015, 375 patients from FQHCs in Ohio with uncontrolled diabetes and/or hypertension were enrolled in a pilot study to determine the impact of pharmacist-provided MTM services on efficacy of patient disease management over a six month period of care. The results indicate:
44.8% of patients with uncontrolled diabetes at baseline were at goal, defined as an HbA1c ≤ 9%, within six months
68.6% of patients with uncontrolled hypertension at baseline were at goal, defined as < 140/90, within six months
75 adverse drug events identified
145 potential adverse drug events were detected and remedied
552 instances of clinical pharmacy services documented
The Development and Execution of Hypertension and Diabetes Self-Management Plans for Patients by Engaging Community Pharmacists
From August 2014-June 2015, 67 patients from a suburban Minneapolis, MN community pharmacy with diabetes and/or hypertension, as determined by their medication list, were surveyed to develop a tool that assists pharmacists in the identification and implementation of diabetes self-management programs and standardize communication with primary care physicians. Results indicate:
Need to refine the worksheet survey further for patients
Need to refine evaluation of medication adherence using recognized measures such as Proportion Days Covered (PDC) and Medication Possession Ratio (MPR)
Physicians prefer one-page standardized forms with relevant, patient-specific information that includes the MN Department of Health logo, along with a clear statement on whether prescriber action is requested or not.
ACO: Accountable Care Organization; NQF: National Quality Form; CAHPS: Consumer Assessment of Health Plans Survey; AHRQ: Agency for Healthcare Research and Quality; CMS:
Centers for Medicare and Medicaid Services; COPD: Chronic Obstructive Pulmonary Disorder; AMA-PCPI: American Medical Association-Physician Consortium for Performance
Improvement; NCQA: National Committee for Quality Assurance; ACC: American College of Cardiology; AHA: American Heart Association
This issue was brought to you by KINBO LEE, a 4th year pharmacy student at the Uni-versity of Maryland, who was on rotation at the CDC Division of Diabetes Translation from March 23—April 24, 2015. Upon graduation in May 2015, he will serve at Federal Correctional Complex (FCC) Tucson managed by the Federal Bureau of Prisons (BOP) to fulfill his payback obligation with the US Public Health Service. In the short term, he hopes to develop his skills as a clinical pharmacist and later, move into a more regulatory setting.