UNT Health Clinical Pharmacist Services Introduction to Pharmacists in Family Medicine Katura Bullock, PharmD, BCPS (katura.bullock@unthsc.edu) Shara Elrod, PharmD, BCGP, BCACP (shara.Elrod@unthsc.edu) Jennifer Fix, PharmD, BCGP, MBA (jennifer.fix@unthsc.edu) Sara Wettergreen, PharmD, BCACP (sara.wettergreen@unthsc.edu) W. Cheng Yuet, PharmD, BCACP (cheng.yuet@unthsc.edu)

Background Value of pharmacists in training of family medicine physicians was first described in 1980s Since that time, there has been increasing involvement of clinical pharmacists as teachers within family medicine residency programs due to Adaptation of PCMH and other interdisciplinary approaches to training family medicine physicians Increasing focus on clinical training in colleges of pharmacy Geyman JP. J Fam Pract 1980;10:21-2 Johnston TS, et al. J Fam Pract 1981;13:91-4

Roles and Outcomes in Patient Care Study Setting Role of the Pharmacist Outcomes Dolovich, 2008 7 family practice sites 6 community sites 1 university-based site Urban, suburban, and rural locations Individual patient medication assessments Healthcare provider education System-level practice enhancements (improve drug prescribing and use) 1,554 patients seen over 24 months 3,975 DRPs identified (average of 4.4 DRPs per patient) ADRs in 241 patients (26.5%) Nichol, 2006 Private, suburban family medicine practice Diabetes management (drug therapy, diet, exercise, foot care) Improvement in A1c, cholesterol, SBP, DBP, and % of patients achieving therapeutic goals Able to generate revenue for the practice Williams, 2010 Inpatient service Medication reconciliation Resolution of drug and dosing issues Medication discharge counseling and follow-up Admissions to the family medicine declined by 9.3% Young, 2011 Urban family medicine clinic Development and use of a physician-approved warfarin dosing protocol, primarily via telephone Significant increase in time in therapeutic range (TTR) and expanded TTR (±0.3) and significant reduction in INR < 1.5 Dawson, 2012 Community hospital family medicine teaching service (also cardiology and IM) Utilization of a detailed warfarin dosing protocol with minimal physician oversight Significant reduction in number of patients with supratherapeutic INR (>5) versus usual care (physician management)(1.85% vs 7.85%; p=0.004) Clinical pharmacists are valued practitioners within family medicine residency programs (FMRPs) in the United States in a variety of inpatient and outpatient settings DRP = Drug-related Problem; ADR = Adverse Drug Reaction; A1c = hemoglobin A1c; SBP = Systolic blood pressure; DBP = Diastolic blood pressure; IM = Internal medicine; INR = International normalized ratio

Clinical Pharmacists in Family Medicine Studies show that clinical pharmacists in family medicine programs have IMPROVED Medication Prescribing Patient Satisfaction Outcomes Robinson JD, et al. Postgrad Med 1982;71(1):97-103 Carter BL, et al. DICP 1984;18:817-21. Helling DK, et al. Am J Hosp Pharm 1979;36:325-9 Wilt DM, et al. Pharmacotherapy 1995;15(6):732-9

Interprofessional Collaboration Collaboration through Patient Care Our Approach to Medication Management

Pharmacist Collaboration Provider Pharmacist Patient

Collaboration through Patient Care The physician is responsible for diagnosis of a condition and together the physician and pharmacist jointly share responsibility for care of the patient Initiating, modifying, and monitoring drug therapy of individual patients or groups of patients Ordering and evaluating the results of laboratory tests directly relating to drug therapy Assessing patient response to therapy Administration of medications, including immunizations Collecting and reviewing patient drug histories Obtaining and checking vital signs Performing physical assessment consistent with the disease state and drug therapy Counseling and education patients about their medications 22 Tex. Administrative Code § 295.13

Our Approach to Medication Management Initiate, modify, and monitor drug therapy Order and evaluate laboratory test results Assess patient response to therapy Drug Therapy Obtain and check vital signs Consistent with disease state and drug therapy Physical Assessment Collect and review patient drug histories Administer medication Counsel and educate patients Patient Interaction 22 Tex. Administrative Code § 295.13

What types of services do we offer? General Medication Management Chronic Disease State Management Patient Education PharmD Educational Seminars Clinic Telephone Calls

Additional Benefits Continuous Quality Improvement Collaborative research opportunities Medication use evaluations In-service presentations for physicians and staff Improved Patient Care Increase physician time for more acute cases Resource for more frequent or urgent follow-ups Resource for patient education Reduced Health Care Costs Improve medication adherence Improve patient accountability

UNT Health Clinical Pharmacist Services Introduction to Pharmacists in Family Medicine Katura Bullock, PharmD, BCPS (katura.bullock@unthsc.edu) Shara Elrod, PharmD, BCGP, BCACP (shara.elrod@unthsc.edu) Jennifer Fix, PharmD, BCGP, MBA (Jennifer.fix@unthsc.edu) Sara Wettergreen, PharmD, BCACP (sara.wettergreen@unthsc.edu) W. Cheng Yuet, PharmD, BCACP (cheng.yuet@unthsc.edu)