Building Successful Provider-Pharmacist Teams in Iowa

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Submission Date: May 2015

State/Territory Submitted on the Behalf of: Iowa

States/Territories Involved: Iowa

Funding Source: CDC

CDC Funding:

Yes

CDC Funding (Specified):

(1305) State Public Health

Domain Addressed:

Community-Clinical Linkages, Health Systems Strategies

Public Health Issue:

  • The Community Preventive Services Task Force (CPSTF) recommends team-based care for improving blood pressure control because there is strong evidence that it is effective. The CPSTF identifies health interventions that are proven to save lives, increase lifespans, and improve quality of life.
  • Very few active provider-pharmacist teams are working in Iowa to help people with high blood pressure control their condition. This is especially true in places where the medical practice doesn’t have its own internal pharmacy.

Project Objectives:

  • To expand care coordination between healthcare providers and community pharmacists
  • To increase contol of high blood pressure through care coordination between healthcare providers and community pharmacists.

Program Action:

  • The Iowa Department of Public Health (IDPH) contracted with the University of Iowa, College of Pharmacy (U of I) to recruit pharmacist/medical provider teams, develop resource materials, facilitate team meetings/training, and monitor the work of the teams.
  • Each team attended a one hour face-to-face training and developed a plan for their collaborative work. Most teams searched EHRs to identify patients mutually served whose blood pressure was not controlled. Providers referred identified patients to the pharmacist who worked with the patient on improving BP control using various methods – monitoring, education, lifestyle modifications, medication reconciliation, medication advice to the physician, and others. Both the practice and the pharmacy received small cash incentives to cover initial staffing and system changes.

Data/Other Information Collected:

After 3-5 months of team work, both team partners participated in a follow-up survey to determine successes and challenges. The U of I evaluation report for the project highlights these results:

  • The number of patients involved in each team’s project and how many patients were able to control/improve their blood pressure.
  • Creation of the training curriculum and project guidebook
  • Creation of a viable model for establishing provider-pharmacist teams
  • The addition by some practices of a procedure to update patient medication lists to include medications prescribed by other providers that were not on the participating physician’s medication list.

The project guidebook provided background materials about the team-based care model for blood pressure management, such as evidence supporting the model, goals for the project, current treatment guidelines, suggestions for team management, sample intervention ideas, and sample educational materials.

Impact/Accomplishments:

  • The project successfully recruited an initial 8 provider-pharmacist teams and trained them to foster team development.
  • Initial results show that 31 of 46 patients with high blood pressure cared for by a provider/pharmacist team reached goal blood pressure.

Challenges/Lessons Learned:

  • The absence of a payment model (an issue the Iowa Pharmacy Association has worked on for years)
  • The difficulty of determining why some teams are successful & others are not.
  • Initial recruitment of teams – partners need to become accustomed to doing this type of work outside of their normal work load.
  • Fostering teamwork – because they often are located in different buildings and different organizations, it is difficult for team members to easily include the other team members. The two most successful teams are in the same building, though the pharmacy & the practice are not jointly owned.

Next Steps:

  • A final report on participating practices will determine how many have continued the care collaboration efforts on their own and provide an analysis of the factors that contributed to successful team care.
  • Areas for improvement in the team building and support were identified and changes will be made based on virtual team principles
  • Health systems in Iowa will be contacted to discuss their interest in the team approach.
  • The team management approach will begin to include diabetes with a focus on controlling A1c levels.

Program Areas:

Health Equity and Cultural Competency

State Contact Information:

IA
Terry Y. Meek, Health Systems Coordinator
Iowa Department of Public Health
515-281-6016
terry.meek@idph.iowa.gov

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