AllianceRx Medication Therapy Management Servicesi

The number of sports enthusiasts using athletic trainers is increasing. Achieving the desired outcome is more probable when one is tutored, cajoled, and required to report periodically on individual performance. Tutelage and shared responsibility is the key. Patients dealing with complex ingrained behaviors like smoking or alcohol addiction are much more successful when they openly share their problems and find new direction from an outside resource person.

What effect then would coaches have on medication therapy outcomes ?
Would this medication therapy coaching lead to therapy goal improvements ? Who should be the coach?

A study called the “Ashville Project” proved that pharmacists could coach diabetic patients and subsequently improve the outcomes related to their treatment. The City of Ashville offered their employees free medications if they participated in medication counseling. Pharmacists in the Ashville project worked with patients to improve their understanding of their medications, complications of the disease, treatment options, the importance of exercise and diet in diabetes care. The program lasted five years and was a complete success.

Diabetic patients were chosen because inadequately treated patients experience many preventable complications that develop slowly over time. Costs of health care for the diabetic patients are greater than for patients without diabetes. Table 1. lists some of the problems experienced by diabetic patients

Table 1. Impact of diabetes

2-4 times increase in risk of Heart disease
Other accompanying medical conditions
hypertension
blindness
renal disease
nerve problems
Increase in time lost from work
Increase in Hospitalizations

Pharmacists in the Ashville project were “diabetic coaches”. Pharmacists reviewed with the patient their actual blood glucose data, discussed improvements in diet and exercise and discussed proper administration of medications. Improvements in the patient's diabetes control reflected by reductions in glycosalated hemoglobin were evident. Optimal glycosalated hemoglobin as defined by the American diabetes Association is
< 7%. In the project average glycosalated hemoglobin was decreased from 7.6 to 6.7. The importance of glycosalated hemoglobin is that it is a reflection of diabetic treatment control over the previous weeks; whereas blood glucose data provides a reflection of blood glucose at a single instance in time.

Equally important is the financial impact that the program provided to the City of Ashville. Medical costs were reduced from $6,200 to $5,200 per patient per year.

Sick leave was reduced by 50%. The City of Ashville estimated when employee productivity was converted to dollars, the city gained $18,000 per year.

Many pharmacies in the community offer Medication Therapy Management services. At the Health Alliance, Medication Therapy Management services are offered at the St. Luke Hospitals, and The University Hospital, The Holmes Hospital and Fort Hamilton Hospital. The counseling at these institutions is directed toward Anticoagulant therapy, diabetes and overall medication management. Listed below are times and services.

Pharmacist Medication Therapy Management services are charged per visit. Some third-party payers will reimburse for the services. The cost of the Medication Therapy Management service can be reimbursed from a medical flexible spending account. Upon physician referral Medicare patients are eligible for counseling.

Medication Therapy Management Services Offered by the Hospitals of the Health Alliance

Counseling: Disease State Management (DM, HTN, COPD, Lipids, Asthma), medication compliance counseling, medication dose titration, smoking cessation, medication administration instruction (inhalers, insulin, glucometers)

Restrictions: per our current policy and procedure, we require a referral from the patient's Primary Care Physician which must be a physician in the General Medicine, Faculty Practice, or Med Peds clinic at Hoxworth.

Hours: Thursday 8:30 AM - 5:00 PM

Counseling: medication adherence counseling, disease state management (focusing on HIV/ AIDS, but including co-morbid disease states), anticoagulation management, medication education, lab monitoring, and medication administration

Restrictions: Must have a primary care physician and must have a referral by a physician. A collaborative practice agreement must be signed with all new patients.

Hours: Monday,Tuesday, Thursday, Friday 7:45-5pm; Wednesday 1-4:30pm
Services Provided: Comprehensive anticoagulation monitoring/adjustment/education; collaborative practice agreements with physicians to provide services for CHF patients

Restrictions: Must have a primary care physician and must have a referral by a physician. A collaborative practice agreement must be signed with all new patients.

Location: First Floor SLE
Hours: Monday,Tuesday, Thursday, Friday 7:45-5pm; Wednesday 1-4:30pm

Services Provided: Comprehensive anticoagulation monitoring/adjustment/education; collaborative practice agreements with physicians to provide services for CHF patients

Restrictions: Must have a primary care physician and must have a referral by a physician. A collaborative practice agreement must be signed with all new patients.