Wait. What? The pharmacist will see me?
Yes, in primary care and some specialty clinics at U-M, pharmacists see patients with medication-responsive chronic conditions, including diabetes, hypertension, high cholesterol, and asthma. They also manage patients who take lots of medications or use them off label.
Under an innovative arrangement with physicians and insurers, clinical pharmacists work directly with patients, ordering new medications and laboratory tests and changing doses as needed. Insurers pay the U-M Faculty Group Practice based on how many patients the pharmacists see and how often.
This past spring, Cornelia Morrison showed up for her appointment with pharmacy PhD Anne Shin Yoo at the U-M’s East Medical Center on Plymouth Rd. Morrison, sixty-five, has high cholesterol, hypertension, and diabetes. But Morrison is the kind of patient health care providers wish for: she has taken charge of her health.
Morrison hands Yoo a small notebook where she’s recorded her blood pressure readings taken at home. Then the Whitmore Lake woman sets up her own monitor and cuff on an exam table.
“Take your blood pressure exactly the way you would do it at home,” Yoo tells her, then takes a look at the notebook. “Your blood pressures at home look fantastic!”
The two review elements of a good diet (Morrison is experimenting with quinoa and has questions about sweet potatoes versus white), the importance of exercising regularly, and Morrison’s glucometer readings that record her blood sugar level.
“Remember, you don’t have to check daily since your blood sugar’s under good control,” the pharmacist tells her. In fact, all three of Morrison’s chronic conditions are now well controlled by medication and lifestyle–so Yoo discharges her back to her primary care physician.
Yoo and other pharmacists free up primary care doctors to focus on more severe or acute matters and help patients who don’t take their medications or don’t use them correctly. Studies show that up to half of patients don’t take their medications correctly, says Hae Mi Choe, the pharmacy PhD who started U-M’s program.
Choe, director of Pharmacy Innovations & Clinical Practices for the U-M faculty practice, is lead author of a paper that found eighty patients with diabetes managed their disease better under the care of a clinical pharmacist than a group that was cared for elsewhere. More recent, although unpublished, data show that 543 patients with diabetes significantly reduced their blood sugar levels while under the care of a pharmacist.
The program is so popular with doctors that specialty clinics like psychiatry, anticoagulation/cardiology, post-transplant endocrinology, and chronic kidney disease asked for and got pharmacists in their practices, too, says pharmacy associate dean Nancy Mason. In all, ten U-M pharmacists now provide direct patient care.
“Physicians are very busy and looking for help in focused ways with patients, whether it’s a dietitian or a pharmacist,” says Connie Standiford, executive medical director of U-M’s Ambulatory Care Services. “We don’t have enough primary care physicians, and this is one way to do things differently.” Dietitians, social workers, and nurses acting as care navigators also work with doctors in U-M’s outpatient clinics.
Pharmacists don’t just take pressure off primary care doctors–Standiford notes that they bring their patients more knowledge and training about medications and supplements. And they’re more convenient: “They also do more telephone visits, and I think patients really like that.”
Thank you for exploring the expanded roles for clinical pharmacy specialists in UM clinics in your August 2015 piece, “Pill Power: The pharmacist will see you now.” The Department of Veterans Affairs (VA) Healthcare Administration has used clinical pharmacy specialists in direct patient care for decades. Twenty PharmDs–I am one–currently play a crucial role in fine-tuning medications for health conditions such as chronic pain, diabetes, hypertension, and heart failure that are difficult to control. Clinical pharmacy specialists have long played a crucial role in direct patient care, and it’s good to see our colleagues (some of whom trained at the VA) doing so at UM.