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Clinical Pharmacy Services: How ADAP Clients Can Benefit !
Clinical Pharmacy Services: How ADAP Clients Can Benefit !
ØZandra M. Glenn, PharmD
ØHRSA- Pharmacy Services Support Center
ØJuly 10, 2008
ØWhat are Clinical Pharmacy Services?
That area of pharmacy concerned with the science and practice of rational medication use. American College of Clinical Pharmacy
Clinical pharmacy is more oriented to the analysis of population needs with regards to medicines, ways of administration, patterns of use and drug effects on the patients. The focus of attention moves from the drug to the single patient or population receiving drugs. European Society of Clinical Pharmacy
Patient-centered services that promote the appropriate selection and utilization of medications. Its objective is to optimize individual therapeutic outcomes. HRSA - PSPC
Ø“Traditional” vs. “Clinical” Pharmacy
ØTraditional Pharmacy Services
lSynthesis and chemistry of medication
lPreparation of drugs
lDispensing medication services
lPRODUCT focus
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ØClinical Pharmacy Services
lIndividualized medication monitoring and evaluation
lPatient-centered care
lIntegrated health care team in which pharmacist is directly involved in patient care
lPATIENT focus
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ØMathematica Report
ØObjective: (in response to the 2007 Senate Appropriations Committee Report) To provide recommendations on how to generate improvements in the use of clinical pharmacy services across all HRSA programs (including ADAP programs) in which medication plays an integral role in patient care.
ØReports will be used for HRSA to draft recommendations/report to Congress.
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ØCase Study Sites
ØVariations in Clinical Services
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ØVariations in Clinical Services
ØReasons for Initiation of Clinical Pharmacy Services
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ØOpportunity for quality improvement with complex patients
ØGrant programs (Federal and State)
Ø“Push” by pharmacy champion
ØCost Containment
l“high volume, high risk, high cost patients”
lFormulary Management
lCost of Indigent Patients
ØPharmacist Interest
ØPhysician Demand
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ØBarriers to Clinical Pharmacy Services
ØFunding / Lack of reimbursement
ØSpace
Ø“Turf issues”
ØPhysician Acceptance / Lack of awareness of pharmacists’ abilities
ØPharmacist recruitment and retention
ØLanguage barriers
ØLack of documentation / tracking to prove impact of clinical services
ØPatients’ lack of awareness of pharmacists’ abilities
ØFinancing
ØGrants (State programs, Ryan White funds, etc.)
ØAdministration allocating funds from other departments
ØLimited Billing
lMedicaid
lMedicare billing (Part B and Part D)
ØColleges of Pharmacy
lFull or partial salary for faculty
lFees to precept students / rotation sites
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ØBenefits of Clinical Pharmacy Services
ØImproved outcomes
ØReduced costs
ØImproved patient access
ØImproved efficiency of medical providers
ØImproved quality of prescribing
ØPatient satisfaction
ØImproved patient knowledge
ØAn Unique Model
ØFL ADAP initiated Clinical Pharmacy Services
ØCollaboration between:
lFL ADAP Program
•Partial funding
lFlorida A&M University College of Pharmacy
•Traditional pharmacy services
•Pharmacy resident
•Partial funding
lFQHC
•Primary care services for ADAP clients
lCounty Health Department
•Facility
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ØRole of Pharmacy Resident
Ø“ADAP pharmacist”
ØWork closely with ADAP coordinator
ØEvaluate labs every 3 months
ØReview and dispense medication regimens
ØIdentify medication management interventions
ØMonitor prescription adherence
ØConsult and educate patients (one-on-one patient visits every 6 months)
ØConsult, educate, and interact with physicians, and support staff (meet with providers weekly)
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ØPharmacists Interventions
ØIdentified Therapeutic Duplication – 5%
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ØAdditional Drug Needed – 20%
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ØIncorrect Therapeutic Dose – 20%
ØPatient Education – 25%
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ØIdentified Adverse Reactions – 30%
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ØNext Steps
ØMake a commitment to provide clinical pharmacy services
ØSeek out collaborating partners
ØThink “outside of the box”
ØEstablish programs to document and track outcomes from clinical programs
ØContact PSSC for help
ØPSSC: Pharmacy Services Support Center
The 340B Access Resource
The 340B Access Resource
ØEstablished through a contract between APhA and HRSA
lEstablished 2002
lRenewed 2007
ØEnhances Office of Pharmacy Affairs (OPA) resources to optimize the value of the 340B program in order to provide affordable, comprehensive pharmacy services that improve medication use and advance patient care and patient access to affordable drugs.
ØPharmacy Services Support Center
ØInformation management
lOrganizing pharmacy expertise and resources
lResponding to 340B inquiries
ØPolicy analysis
lMonitoring pertinent policy developments
lCommunication and education on policy issues and Medicare
ØNetworking
lCommunication and education
lPresentations
lProject development
ØPSSC PharmTA
ØFree technical assistance for 340B-eligible entities interested in setting up or enhancing clinically and cost effective pharmacy services
ØPharmTA consists of a pool of pharmacy experts who work one-on-one with entities through phone and/or on-site consultations to maximize 340B at individual entities
ØContact Information
Zandra Glenn, PharmD
1-800-628-6297
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