Virtual pharmacist consultation services in an ambulatory care setting: a single site pilot

Chelsey Hess, PharmD; Clint Hinman, PharmD, MPH; Samantha Lippolis, MPA; Karlyn Jenkins, PharmD; Claire Swartwood, PharmD, BCPS

Background Telehealth Clinic Workflow Discussion

 Medication Recommendations  Pharmacy Services are currently underutilized in primary care settings  Physician made changes to patients’ medications outside of pharmacy within Centura Health recommendations  Pharmacist intervention for complex medication management  It is common practice to only make one medication change per visit, especially for improves patient outcomes1,2 complex patients  Telehealth is not a new concept, but has evolved with expansion of  Not all physician visits were medication focused health information technology6  Immunization Recommendations  Allows pharmacists to extend expertise to multiple locations without the  Clinic initiation was toward end of influenza season burden of physical presence  Zostavax (Zoster vaccine) only covered under Medicare Part D – patients advised to get at retail pharmacy  Tdap not covered by Medicare (cost ~$100) – patients counseled on this vaccine, but Description chose not to get it  Pharmacist recommendations to change/discontinue some medications lead to avoidance of further AE  Virtual pharmacy services via video conferencing consultations (comprehensive medication reviews) were implemented at the CHPG Conclusion/Future Directions (Centura Health Physician Group_ Sports & Family Medicine Clinic in Arvada, CO  Virtual pharmacy via video conferencing allows pharmacists to extend expertise  Clinic was run by pharmacy residents based at St. Anthony Hospital in to off-site locations and can contribute to improved patient outcomes Lakewood, CO  Patients and providers responded well to this service  Since implementation, this clinic has expanded to include 2 additional clinics: St. Anthony North Family Medicine clinics at 144th Ave. and 84 Ave. Objectives  New resident pharmacists at St. Anthony Hospital are now running the Outcomes/Results telepharmacy clinic  Primary objective References  To determine if virtual pharmacist consultation services providing Qualifying patients Qualifying patients 95%CI PRE-telepharmacy SEEN 1. Chisholm-Burns MA, Kim Lee J, Spivey CA, et al. US pharmacists’ effect as team members on patient care: systematic review and meta-analyses. medication recommendations to providers leads to lower hospital intervention by telepharmacist Med Care. 2010;48(10):923-933. readmission and emergency room visits (n=19) (n=15) 2. Smith M, Bates DW, Bodenheimer T, Cleary PD. Why pharmacists belong in the medical home. Health Aff. 2010;29(5):906-913. 3. Vande Greind JP, Saseen JJ, Bislip D, et al. An Off-Site Clinical Pharmacy Service in Family Medicine: Development and 1-Year Outcomes. Fam  Secondary objectives # Hospital 0 0 -0.25 – 0.21 Med. 2014;46(5):348-353. 4. Vande Griend JP, Saseen JJ, Bislip D, et al. Prioritization of Patients for Comprehensive Medication Review By a Clinical Pharmacist in Family re-admissions Medicine. JABFM. 2015;28(3):418-424  To track recommendations made by resident pharmacists 5. Kaldy J. Telehealth Enables Senior Care Pharmacists to Reach Beyond Facility Walls. Consult Pharm. 2005;20(6):558-567. # ED visits 0 0 -0.25 – 0.21  Provider and patient satisfaction with pharmacy consultation services 6. Esterle L, Mathieu-Fritz A. Teleconsultation in geriatrics: Impact on professional practice. Int J Med Inform. 2013;82:684-69. 7. Singh LG, Accursi M, Black KK. Implementation and outcomes of a pharmacist-managed clinical video telehealth anticoagulation clinic. Am J Health- # UC visits 0 1 -0.15 – 0.34 Syst Pharm. 2015;72:70-73.  Assessed via brief surveys 8. Lam A. Practice Innovations: Delivering Medication Therapy Management Services via Videoconference Interviews. Consult Pharm. 2011;26(10):764-774. 9. Darkins A, Ryan P, Kobb R, et al. Care Coordination/Home Telehealth: The Systematic Implementation of Health Informatics, Home Telehealth, and Other interventions: Disease Management to Support the Care of Veteran Patients with Chronic Conditions. Telemed J E Health. 2008;14(10):1118-1126.  25 recommendations made Implementation Timeline  8 accepted by physician (32% acceptance rate) Disclosures  13 Immunization recommendations made September 2016 – February 2017 • Authors of this presentation have the following to disclose concerning possible financial or personal relationships with  4 administrations (30.8% acceptance rate) commercial entities that may have a direct or indirect interest in the subject matter of this presentation. Logistics and clinic set-up • Chelsey Hess: Nothing to disclose  4 laboratory recommendations made • Karlyn Jenkins: Nothing to disclose • Clint Hinman: Nothing to disclose • Claire Swartwood: Nothing to disclose  3 labs ordered (75% acceptance rate) • Samantha Lippolis: Nothing to disclose February 6 to March 3, 2017  6 adverse events identified via patient interview  3 reconciled duplications Correspondence Pre-telepharmacy intervention data collection  12 medications discontinued (no longer indicated) Chelsey Hess, PharmD  6 dosing reconciliations (patient taking differently than listed) Clinical Pharmacy Specialist March 6 to March 31, 2017  Survey results showed that overall provider and patient satisfaction improved with Centura Health, Centennial, CO implementation of telepharmacy services Email: [email protected] Telepharmacy service implementation and post-implementation data collection Phone: 303-673-7373