Advancing pharmacy practice model initiatives

Current healthcare reform initiatives emphasize high quality, safe, and cost-effective care, and greater accountability for those who seek to provide it. The ability of key stakeholders along the care continuum to work collaboratively will be critical to achievement of these goals. In response to these priorities, the Hospital and Health-System Pharmacy Practice Model Initiative (PPMI) highlights a future-oriented model that supports and recognizes the impact of pharmacists, in particular, as providers of direct patient care.

The American Society of Health-System Pharmacists (ASHP) and the ASHP Research and Education Foundation sponsored PPMI with the objective of determining patient-care-related services that should fall under the responsibility of pharmacists working alongside physicians, nurses, and other clinicians. The model acknowledges transitional hurdles but also emphasizes the importance of identifying emerging technologies to assist with successful integration of a new framework.

Clinical faculty from the Ernest Mario School of Pharmacy at Rutgers, the State University of New Jersey, use their clinical specialty expertise in a variety of settings to align the Doctor of Pharmacy curriculum with professional goals and evolving healthcare demands.

Easily accessible drug-reference databases and resources are critical to effective execution of patient-care services. For example, at an associated teaching site, Monmouth Medical Center (an affiliate of the Saint Barnabas Healthcare System in Long Branch, N.J.), both pharmacists and students consider the availability of these tools indispensible to successful completion of their responsibilities.

Leveraging the tools

An indisputable focal point for all stakeholders today is a reconstructed strategy for affordable healthcare. The goal is unanimously to derive the most cost-effective model, but the dynamics of such an accomplishment are highly complex.

Consider that one of the focal points of PPMI is to advance the role of pharmacy in transition of care - an area increasingly recognized as fundamental to improvement of outcomes, especially for patients identified as high-risk for readmission. Alongside a growing body of research related to care transitions, a paper published in the November 2012 issue of Pharmacotherapy points to the critical role adverse drug events (ADEs) play in readmission rates and how ineffective care transitions, especially as they relate to medication management, exacerbate the situation.

A characteristic high-risk patient will typically have multiple comorbidities, often receive expert care from more than one specialty provider, and fill prescription medications through more than one outlet. This complex combination can create a perfect storm of confusion for patients who lack the knowledge to accurately communicate medical history.

Simplify and individualize

Drug reference and interactions databases appeal to the goal of simplification. Through use of an advanced drug reference solution, pharmacists at Monmouth Medical Center are able to individualize a pharmacotherapeutic plan efficiently to identify potential drug-drug interactions, disease-related concerns, dosing adjustments, and special FDA alerts or black-box warnings.

The pharmacist following a patient’s inpatient progress can then optimize the management plan on a daily basis, maximizing safety and efficacy when information is quickly and readily accessible during such times as interdisciplinary patient care rounds. 

While use of the drug-information database and its integration into workflow vary by healthcare provider and the clinical practice area, the dosing recommendations are used universally.

Pharmacy professionals appreciate quick access to clear, concise, and reliable information that is updated daily by the solution’s team of in-house experts.

Drug-comparison reviews by class, providing a quick summary of information - even as quick pocket-reference sheets - have also enabled high optimization of medication plans for patients.

Specific clinical resources

Specific clinical databases provide more in-depth application to the workflows and patient needs of a particular specialization.

For instance, it is very common to find medical teams responsible for patient discharge using patient-education sheets for first dose-administration education, or decentralized pharmacists completing discharge counseling, as well as physicians researching indications for an extensive list of home medications.

Also, in such areas as pediatrics, where the breadth of evidence-based literature is more limited, pharmacists can access direct links to the most recent references available, creating efficiencies in the quest for best practices.

This has become a critical tool for finding guidance based on the pooled available evidence and consistently provides a list of supporting references, as well.

The functional capacity of the database extends beyond direct patient care. For example, management of infectious disease is often largely directed by hospital policies and protocols governing the judicious use of antibiotics. In such instances, the database serves as an information resource, particularly in evaluation and comparison of criteria pertinent to development of the most cost-effective, institution-specific guidance.

Patient education strategies

Health literacy and better patient engagement are focal points of national initiatives. Consider that a recent report from the Institute of Medicine (IOM) points to an alarming reality: Among American adults, nearly half (90 million people) possess limited health literacy. As progress continues toward care-delivery models that more fully engage patients in their own healthcare, the use of a robust drug-information database can have an equal impact on patient education.

Pharmacy personnel at Monmouth Medical Center have found that when essential information can be easily relayed and provided in a concise and non-threatening manner, patients appreciate having greater autonomy and involvement in their care.

Printable medication-specific patient-education leaflets equip pharmacists with tools that better ensure patients are properly versed in treatment objectives. In order that useful materials may be properly disseminated, the information must be available in a wide variety of languages and easily understood by all patients affected by limited health literacy. 

Also critical to overcoming literacy challenges is the need for educational materials to be presented in simple sentences written between fifth- and seventh-grade reading levels. Brief bulleted statements are more effective than long paragraphs, and the use of print in larger fonts addresses the needs of the vision-impaired.

The evolution of PPMI across the healthcare landscape has potential to take patient care to the next level and especially to address the need for more focused attention on transitions of care.

In order to move these strategies forward, pharmacists need to be armed with the best information at the point of care. Going forward, the use of comprehensive drug-information databases will be a critical part of overall strategies to promote best practices of pharmacists, as they take a more elevated role in direct patient care.

Millie Rajyaguruis a clinical assistant professor with the Ernest Mario School of Pharmacy at Rutgers University.