Clinical Pharmacy Services: How ADAP Clients Can Benefit !

1. Clinical Pharmacy Services: How ADAP Clients Can Benefit ! Zandra M. Glenn, PharmD HRSA- Pharmacy Services Support Center July 10, 2008

2. What 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

3. “Traditional” vs. “Clinical” Pharmacy • Traditional Pharmacy Services • Synthesis and chemistry of medication • Preparation of drugs • Dispensing medication services • PRODUCT focus • Clinical Pharmacy Services • Individualized medication monitoring and evaluation • Patient-centered care • Integrated health care team in which pharmacist is directly involved in patient care • PATIENT focus

4. Mathematica Report • Objective: (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. • Reports will be used for HRSA to draft recommendations/report to Congress.

5. Case Study Sites

6. Variations in Clinical Services

7. Variations in Clinical Services

8. Reasons for Initiation of Clinical Pharmacy Services • Opportunity for quality improvement with complex patients • Grant programs (Federal and State) • “Push” by pharmacy champion • Cost Containment • “high volume, high risk, high cost patients” • Formulary Management • Cost of Indigent Patients • Pharmacist Interest • Physician Demand

9. Barriers to Clinical Pharmacy Services • Funding / Lack of reimbursement • Space • “Turf issues” • Physician Acceptance / Lack of awareness of pharmacists’ abilities • Pharmacist recruitment and retention • Language barriers • Lack of documentation / tracking to prove impact of clinical services • Patients’ lack of awareness of pharmacists’ abilities

10. Financing • Grants (State programs, Ryan White funds, etc.) • Administration allocating funds from other departments • Limited Billing • Medicaid • Medicare billing (Part B and Part D) • Colleges of Pharmacy • Full or partial salary for faculty • Fees to precept students / rotation sites

11. Benefits of Clinical Pharmacy Services • Improved outcomes • Reduced costs • Improved patient access • Improved efficiency of medical providers • Improved quality of prescribing • Patient satisfaction • Improved patient knowledge

12. An Unique Model • FL ADAP initiated Clinical Pharmacy Services • Collaboration between: • FL ADAP Program • Partial funding • Florida A&M University College of Pharmacy • Traditional pharmacy services • Pharmacy resident • Partial funding • FQHC • Primary care services for ADAP clients • County Health Department • Facility

13. Role of Pharmacy Resident • “ADAP pharmacist” • Work closely with ADAP coordinator • Evaluate labs every 3 months • Review and dispense medication regimens • Identify medication management interventions • Monitor prescription adherence • Consult and educate patients (one-on-one patient visits every 6 months) • Consult, educate, and interact with physicians, and support staff (meet with providers weekly)

14. Pharmacists Interventions • Identified Therapeutic Duplication – 5% • Additional Drug Needed – 20% • Incorrect Therapeutic Dose – 20% • Patient Education – 25% • Identified Adverse Reactions – 30%

15. Next Steps • Make a commitment to provide clinical pharmacy services • Seek out collaborating partners • Think “outside of the box” • Establish programs to document and track outcomes from clinical programs • Contact PSSC for help

16. PSSC: Pharmacy Services Support CenterThe 340B Access Resource • Established through a contract between APhA and HRSA • Established 2002 • Renewed 2007 • Enhances 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.

17. Pharmacy Services Support Center • Information management • Organizing pharmacy expertise and resources • Responding to 340B inquiries • Policy analysis • Monitoring pertinent policy developments • Communication and education on policy issues and Medicare • Networking • Communication and education • Presentations • Project development

18. PSSC PharmTA • Free technical assistance for 340B-eligible entities interested in setting up or enhancing clinically and cost effective pharmacy services • PharmTA 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 • For more information: 1-800-628-6297 or visit http://pssc.aphanet.org/

19. Contact Information Zandra Glenn, PharmD rzglenn@comcast.net 1-800-628-6297 http://pssc.aphanet.org/