Jan D. Hirsch, BSPharm, PhD, FNAP Chair Clinical Pharmacy

Slides:



Advertisements
Similar presentations
Role of the Pharmacist in Collaborative Care for Mental Health and Addiction Treatment in Medically Underserved Appalachia Sarah T. Melton, PharmD,BCPP,CGP.
Advertisements

Disease State Management The Pharmacist’s Role
CVD prevention & management: a new approach for primary care Rod Jackson School of Population Health University of Auckland New Zealand.
2.11 Conduct Medication Management University Medical Center Health System Lubbock, TX Jason Mills, PharmD, RPh Assistant Director of Pharmacy.
Stanford Prevention Research Center STANFORD SCHOOL OF MEDICINE National Trends in the Prescribing of Anti-Hypertensive Medications Jun Ma, MD, PhD Research.
Pharmacist Collaborative Practice Privileges in Diabetes Management
Management of Hypertension according to JNC 7 BY SANDAR KYI, MD.
Can barbers cut BP too? the BARBER-1 trial… Ron Victor, M.D. Burns & Allen Chair in Cardiology Research Professor of Medicine, UCLA Director, Hypertension.
Assessment, Targets, Thresholds and Treatment Bryan Williams NICE clinical guideline 127.
Heart Health Project University of Pennsylvania School of Medicine American Heart Association Pennsylvania State University Funded by the Robert Wood Johnson.
Darren A. DeWalt, MD, MPH Division of General Internal Medicine Maihan B. Vu, Dr.PH, MPH Center for Health Promotion and Disease Prevention University.
Program Collaboration and Service Integration: An NCHHSTP Green paper Kevin Fenton, M.D., Ph.D., F.F.P.H. Director National Center for HIV/AIDS, Viral.
Basma Y. Kentab MSc.. 1. Define ambulatory care 2. Describe the value of ambulatory care practices 3. Explore pharmacy services in some ambulatory care.
LDL Program Medical Management Philip E. Johnston, Pharm.D.
Peter Emery, MD Specialist in Clinical Hypertension InterMed Portland, ME.
DION GALLANT, MD PRIMARY CARE SERVICE LINE MEDICAL DIRECTOR PRESBYTERIAN MEDICAL GROUP JNC 8.
Combination Therapy for Hypertension Summary and Comment by Harlan M. Krumholz, MD, SM Published in Journal Watch Cardiology December 3, 2008Journal Watch.
Background  Obesity is an extremely common problem ~ 1/3 of adult Americans are obese  Patients commonly ask physicians for advice on weight loss, yet.
Accountable Care Organizations at UCSF Adrienne Green, MD Associate Chief Medical Officer, UCSF Medical Center.
Improving Hypertension Quality Measurement Using Electronic Health Records S Persell, AN Kho, JA Thompson, DW Baker Feinberg School of Medicine Northwestern.
10 Points to Remember on An Effective Approach to High Blood Pressure ControlAn Effective Approach to High Blood Pressure Control Summary Prepared by Debabrata.
California Chronic Care Learning Communities Initiative Collaborative Final Outcomes Congress December 9, 2005.
MEDICATION THERAPY MANAGEMENT SERVICES PROVIDED BY PHARMACISTS AND STUDENT PHARMACISTS IN AMBULATORY CARE CLINICS Timothy Cutler, Pharm.D., CGP Kaitlin.
HvC Comparative Effectiveness Project Groups 5 and 6
Pharmacist-Physician Collaborative Medication Therapy Management Services (MTMS) PI: Jan Hirsch, RPh, PhD Carol M. Mangione, MD, MSPH Barbara A. Levey.
Federal Study of Adherence to Medications (FAME) Trial Presented at The American Heart Association Annual Scientific Session 2006 Presented by Dr. Allen.
Hypertension Family Medicine Specialist CME October 15-17, 2012 Pakse.
BARBER-1 (Barber-Assisted Reduction in Blood Pressure in Ethnic Residents) A randomized study investigating the effect of having the local barber encourage.
Connecting Hypertensive Patients at the Physican’s Free Clinic to a Primary Care Provider Ariel Kanevsky, Ranjit Ganguly, Brittany Shrefler, Maarten Galantowicz.
Transforming Care in Patient Centered Medical Home and Accountable Care Organization Hae Mi Choe, PharmD Director, Pharmacy Innovations & Partnerships.
Ross T. Tsuyuki, BSc(Pharm), PharmD, MSc, FCSHP, FACC Yazid NJ Al Hamarneh, BPharm, PhD Charlotte Jones, MD, PhD, FRCP(C) Brenda Hemmelgarn, MD, PhD, FRCP(C)
“Caring for our community’s health since 1973” Presented By Debra Rosen, RN, MPH Director, Quality & Health Education CCALAC Symposium All Heart Hypertension.
References 1.Buse JB, Ginsberg HN, Bakris GL, et al. Primary prevention of cardiovascular diseases in people with diabetes mellitus: a scientific statement.
A Randomized Trial of Intensive versus Standard Blood-Pressure Control The SPRINT Research Group* November 9, /NEJMoa R2 이성곤 /pf. 우종신.
Pharmacy Health Information Technology Collaborative Presenter: Shelly Spiro RPh, FASCP Pharmacy HIT Collaborative, Executive Director.
Expanding the Role of the Pharmacist Enhancing Performance in Primary Care through Implementation of Comprehensive Medication Management.
Joint reporting from Hill Physicians and Sutter Independent Physicians 1.
Clinical Quality Improvement: Achieving BP Control
The AHRQ Safety Program for Improving Antibiotic Use
Management of Hypertension according to JNC 7
Medication therapy management
Nephrology Journal Club The SPRINT Trial Parker Gregg
Models of Primary Care Primary Care – FAMED 530
ACCORD Design and Baseline Characteristics
CDC’s 6|18 Initiative: Accelerating Evidence into Action American College of Preventive Medicine Utilizing the 6|18 Initiative to Address High Blood.
Copyright © 2011 American Medical Association. All rights reserved.
Office of Health Systems Collaboration
Hypertension November 2016
Research Questions Does integration of behavioral health and primary care services, compared to simple co-location, improve patient-centered outcomes in.
Exercise Adherence in Patients with Diabetes: Evaluating the role of psychosocial factors in managing diabetes Natalie N. Young,1, 2 Jennifer P. Friedberg,1,
Impact and costing of cardiovascular disease treatmentin Kwara State Health Insurance (KSHI) program. University of Ilorin Teaching Hospital (UITH) Amsterdam.
Analyze performance Reference:
Health and Human Services National Heart, Lung, and Blood Institute
A Team-Based Approach to Hypertension Control
Vanguard Phase Results for the Blood Pressure Component
San Francisco County OBOT Pilot: Pharmacy Aspects
Introduction to Clinical Pharmacy
Hypertensive Guidelines
Health Home Program Services for Patient 1st Medicaid Recipients
SAMPLE – Preliminary Results
Blood-Pressure Reduction
G0507 Care Management Services for Behavioral Health Conditions
2014 Update on Hypertension
Table of Contents Why Do We Treat Hypertension? Recommendation 5
Beth Wallace, BSN, RN-BC, FNP-S Fairfield University Summer 2010
Primary Hypertension Max C. Reif, M.D.
ICARE Trial Survey Post-Analysis
Hypertension November 2016
Pharmacological Treatment of Hypertension Update 2012
Florian Rader, M.D, M.Sc. C. Adair Blyler, Pharm.D.
Presentation transcript:

Moving forward with Community Pharmacies and Additional Community Settings Jan D. Hirsch, BSPharm, PhD, FNAP Chair Clinical Pharmacy UC San Diego School of Pharmacy

Can barbers cut BP too? Ron Victor, M.D. Burns & Allen Chair in Cardiology Research Professor of Medicine, UCLA Director, Hypertension Center Associate Director, Cedars-Sinai Heart Institute It’s a real honor to join team Cedars and I want to thank everyone for making me feel so welcome. I’m going to tell you about the barbershop HTN study I started in Dallas and, with your help, will re-invent in LA. But first some back ground about HTN in AA.

Background: Non-Hispanic Black Men Highest HTN-death rate in the U.S. Less physician interaction and lower HTN treatment & control rates than black women Are barbershops the right place to improve HTN control? It’s a real honor to join team Cedars and I want to thank everyone for making me feel so welcome. I’m going to tell you about the barbershop HTN study I started in Dallas and, with your help, will re-invent in LA. But first some back ground about HTN in AA.

N Engl J Med 2018; 378:1291-1301

Enhanced Intervention 40 Barbershops randomized (500 patrons) Baseline 20 barbershops 15 patrons/shop Enhanced Intervention Barber-pharmacist BP mgt. Active Comparator Barber health educator 6 Month Follow up Extension Study 12 Month Follow up Male BARBER-1 was a cluster randomized trial conducted on 1300 HTV male patrons of 17 AA-owned barbers in Dallas county Texas

Role Model Poster Characterization: 45 year old man recently diagnosed hypertension, diabetes and high cholesterol Membership: recent hypertension Risk Behavior: no regular doctor Goal: get a regular doctor Influencing factor: social support Barrier to change: too busy working and taking care of children to take care of himself Positive Outcome: be there for his children Stage of Change: Contemplation to Action

Enhanced Intervention Barber‘s Blood Pressure Work Station Wireless transmission Also Both groups will get results of their BP readings by independent survey staff at baseline and at 6- and 12- month follow-up. Cohort member card with barcode Pharmacist visits

Pharmacists Role in Barbershop HTN Program At least monthly appointments in barbershops Check BP Modify drug therapy under full scope collaborative practice agreement Monitor electrolytes –iStat device Send progress notes to PCP South Central LA pharmacy delivered medications to barbershops It’s a real honor to join team Cedars and I want to thank everyone for making me feel so welcome. I’m going to tell you about the barbershop HTN study I started in Dallas and, with your help, will re-invent in LA. But first some back ground about HTN in AA.

Intervention Group HTN Medication Management Approach Step 1: CCB + ARB or ACEi amlodipine + telmisartan Step 2: + thiazide-type diuretic indapamide Step 3: + aldosterone antagonist eplerenone It’s a real honor to join team Cedars and I want to thank everyone for making me feel so welcome. I’m going to tell you about the barbershop HTN study I started in Dallas and, with your help, will re-invent in LA. But first some back ground about HTN in AA.

Baseline Characteristics Intervention Group (N=132) (95% cohort retention) Male Characteristics Intervention Group (N=132) Control Group (N=171) # of Barbershops 28 24 Years in Business 17.3 +/- 14.2 18.1 +/- 8.3 # of Participants 132 171 Age- yrs 54.4 +/- 1-.2 54.6 +/- 9.5 Married 47% 50% Household income < $25,000 41% 30% Any health insurance 85% 88% Regular medical provider 77% 79% Barbershop Patronage Duration- yrs Frequency of visits (every # of weeks) 10.2 +/- 9.6 2.0 +/- 0.9 11.5 +/- 9.0 2.1 +/- 1.1

Barbershop Project: Results Intervention Group (N=132) Outcome Intervention Group (N=132) Control Group (N=171) Systolic Blood Pressure- mmHg Baseline 6 months 152.8 +/- 10.3 125.8 +/- 11.0 154.6 +/- 12.0 145.4 +/- 15.2 Hypertension Control at 6 mos.- no. (%) BP < 140/90 mmHg BP < 135/85 mmHg BP < 130/80 mmHg 118 (89.4) 109 (82.6) 84 (63.6) 55 (32.2) 32 (18.7) 20 (11.7) Mean no. of blood pressure medications per participant 2.6 +/- 0.9 1.4 +/- 1.4 Drug Class- no. (%) ACEi or ARB Calcium channel blocker Diuretic Aldosterone antagonist Beta-blocker 130 (98.5) 125 (94.7) 61 (46.2) 14 (10.6) 71 (41.5) 56 (32.7) 49 (28.7) 2 (1.2) 33 (19.3)

What Made Intervention Work: Multifaceted Pharmacists: PharmD with training by MD specialists Convenient Access More intensive medication therapy than PCPs 2 more medications per patron More potent choices in each drug class (e.g., telmisartan, indapamide) Lower BP target (<130/80 mmHg vs. 140/90) Consistent patronage Endorsement by barbers It’s a real honor to join team Cedars and I want to thank everyone for making me feel so welcome. I’m going to tell you about the barbershop HTN study I started in Dallas and, with your help, will re-invent in LA. But first some back ground about HTN in AA.

Next Steps: Sustainment and Spread Collaboration with LAC DPH, Cedars-Sinai, USC School of Pharmacy on CDC grant SB 1264: Medi-Cal payment for hypertension medication management provided by qualified pharmacists Expand availability of Comprehensive Medication Management, including hypertension, in community pharmacies through the California Right Meds Collaborative Educate all stakeholders about the value of pharmacists providing CMM

Moving forward with Community Pharmacies

Moving forward with Community Pharmacy Collaborative practice protocol between primary care physicians (PCPs) and community pharmacies Literature reveals? Experience and Challenges Key elements for an implementation plan to improve hypertension management

Collaborative Practice Protocol with Community Pharmacies: Literature Limited number of studies Limited description of implementation Key elements Patient population Scope of agreement/protocol Pharmacist credentials Integration between organizations IT Processes Communication

Collaborative Practice Protocol between separate entities: Experience Scope of Agreement Hypertension meds only? Multiple physicians? Sites? Which patients? How identify? Pharmacist credentials Access Electronic Medical Record Credentialing and Privileging Pharmacists and Staff Remote Access Documentation & Communication Templates Communication Pharmacist, Physician, Staff, Patient Organizations

Hypertension Collaborative Practice Protocol What do you think? Best models for Collaborative Practice Protocols Key players, components & processes Barriers to Creating Implementing Assessing Outcomes Facilitators Hypertension Collaborative Practice Protocol Community PCPs and Community Pharmacists

Next Steps for Implementation in Your Community?