Collaborative Drug Therapy Management in NYS: Impact on Pharmacy Practice

1. Collaborative Drug Therapy Management in NYS:Impact on Pharmacy Practice Kimberly Zammit, PharmD, BCPS, FASHP NYS Board of Pharmacy Chair, CDTM Implementation Committee September 23, 2014

2. Disclosures • None to report

3. Collaborative Drug Therapy ManagementACCP Position Statement • Agreement between one or more physicians and pharmacists • Qualified pharmacists working within the context of a defined protocol are permitted to assume professional responsibility for: • Performing patient assessments • Ordering drug therapy-related laboratory tests • Administering drugs • Selecting, initiating, monitoring, continuing, and adjusting drug regimens. (aka prescribing) Pharmacotherapy 2003;23:1210-1225

4. CDTM in the U.S. 2012 Very limited in any setting Any setting Health-systems No CDTM http://www.cdc.gov/dhdsp/pubs/docs/Pharmacist_State_Law.PDF

5. Giberson S, Yoder S, Lee MP. Improving Patient and Health System Outcomes through Advanced Pharmacy Practice. A Report to the U.S. Surgeon General. Office of the Chief Pharmacist. U.S. Public Health Service. Dec 2011. http://www.usphs.gov/corpslinks/pharmacy/sc_comms_sg_report.aspx

6. Report to the Surgeon GeneralObjectives • Obtain advocacy from the U.S. Surgeon General to: • Acknowledge pharmacists that manage disease through medication use and deliver patient care services, as an accepted and successful model of health care delivery in the United States, based on evidence-based outcomes, performance-based data and the benefits to patients and other health system consumers. • Recognize pharmacists, who manage disease and deliver many patient care services, as health care providers. One such action is advocate to amend the Social Security Act to include pharmacists among health care professionals classified as “health care providers.” • Have pharmacists recognized by CMS as Non-Physician Practitioners in CMS documents, policies, and compensation tables commensurate with other providers, based on the level of care provided. • Advance beyond discussion (and numerous demonstration projects) of the expanded roles of pharmacist-delivered patient care and move toward health system implementation

7. Report to the Surgeon GeneralEconomic Benefit

8. Response from the Surgeon General • Publically supports the role of pharmacists in collaborative practice • Evidence and outcomes presented support the following: • Health-care leadership and policy makers should explore ways to optimize the role of pharmacists through collaborative practice • Collaborative practice will improve quality, contain costs and increase access to care • Recognition of pharmacists as health care providers, clinicians and an essential part of the health care team is appropriate given the level of care they provide in many settings • Compensation models reflective of the range of care provided are needed for sustainability http://www.usphs.gov/corpslinks/pharmacy/sc_comms_sg_report.aspx

9. NYS CDTM Demonstration Project

10. NYS CDTM Demonstration Project Report • CDTM legislation passed in 2011required the development of a report: • Review the extent to which CDTM was implemented in New York State • Examine whether and the extent to which CDTM contributed to the improvement of quality of care for patients, reduced the risk of medication error, reduced unnecessary health care expenditures and was otherwise in the public interest. • Make recommendations regarding the extension, alteration and/or expansion of these provisions • Make any other recommendations related to the implementation of CDTM

11. http://www.op.nysed.gov/news/cdtmreportmay2014final.pdf

12. CDTM Report Writing Committee • Board of Pharmacy • CDTM Implementation Committee • Kimberly Zammit, PharmD, BCPS, FASHP • Leigh Briscoe-Dwyer, PharmD, BCPS, FASHP • Lawrence Mohkiber, RPh, MS • Kimberly Leonard, RPh • Participant Representatives • Kelly Rudd, PharmD, BCPS,CACP • Bassett Healthcare • Lisa Phillips, PharmD, CACP, BAAP • Upstate Medical Center • Mark Sinnett, PharmD, FASHP • Montefiore Medical Center

13. CDTM Demonstration Sites* * Programs submitting data

14. CDTM Demonstration Project Results

15. Anticoagulation

16. Anticoagulation ManagementTime in Target Range Rose AJ, et al. Circ CardiovascQual Outcomes. 2011; 4:416-424.

17. Anticoagulation Management

18. Anticoagulation Participants • Kelly Rudd, PharmD, BCPS,CACP • Bassett Healthcare • Valery L. Chu, PharmD, BCACP, CACP • Kingsbrook Jewish Medical Center • Henry Cohen, MS, PharmD, FCCM, BCPP, CGP • Kingsbrook Jewish Medical Center • Lindsey Wormuth, PharmD • United Health Services Hospitals • Rebecca Arcebido, PharmD, BCACP • Patient Centered Medical Home • The Brooklyn Hospital Center • Julie Anne Billedo, PharmD, BCACP • Patient Centered Medical Home • The Brooklyn Hospital Center • Robert DiGregorio, PharmD, BCACP • The Brooklyn Hospital Center

19. Diabetes

20. Demographics

21. Target Hemoglobin A1C

22. Change in Hemoglobin A1C

23. Diabetes Participants • Lisa Phillips, PharmD, CACP, BAAP • St John Fisher College / WSOP • Upstate Medical University • Mary Jo Lakomski, BS Pharm, CDE, BCACP • Upstate University Hospital • Robert DiGregorio, PharmD, BCACP • The Brooklyn Hospital Center • Alex DeLucenay, PharmD, BCACP • St John Fisher College, WSOP • Rochester General Hospital • Asim M. Abu-Baker, PharmD, CDE • St. John Fisher College, WSOF • Anthony Jordan Health Center

24. Heart Failure

25. Demographics

26. Re-Hospitalization • 30 days • Among 22 patients who were seen at the clinic within two weeks after discharge, the 30-day readmission rate was 9% (2 /22). • 90 days • 42 patients had at least one hospitalization in the prior 3 mos • Five patients (12%) have not reached the three month time point • 28 patients (67%) were not hospitalized • In comparison to the previous 3 months: • Three patients (7%) had one less hospitalization • Two patients (4.5%) had one more hospitalization • Four patients (9.5%) had one hospitalization prior to and one hospitalization after their clinic visits

27. Pharmacist Interventions

28. Therapy Optimization

29. Adherence Problems Resolved

30. Heart Failure Participants • Angela Cheng, PharmD, BCPS • Montefiore Medical Center • Danielle Garcia, PharmD, BCPS • Montefiore Medical Group – Bronx East • Charnicia E. Huggins, PharmD, MS • Touro College of Pharmacy • Bronx Lebanon Hospital

31. HIV

32. Pharmacist Interventions

33. Patient Satisfaction 1 = Strongly disagree 2 = Somewhat disagree 3 = Somewhat agree 4 = Strongly agree

34. HIV Participant • Agnes Cha, PharmD, AAHIVP, BCACP • Arnold and Marie Schwartz School of Pharmacy and Health Sciences / Long Island University • The Brooklyn Hospital Center

35. Oncology

36. Pharmacist InterventionsMemorial Sloan Kettering Cancer Center

37. Provider SatisfactionMSKCC

38. Pharmacist InterventionsRoswell Park Cancer Institute

39. Provider SatisfactionRPCI

40. Patient SatisfactionRPCI

41. Oncology Participants • Elizabeth Hansen PharmD, BCOP • Roswell Park Cancer Institute • Richard Tizon, PharmD, BCOP • Memorial Sloan-Kettering Cancer Center

42. Asthma

43. Pharmacist Interventions

44. Asthma Participant • Robert DiGregorio, PharmD, BCACP • The Brooklyn Hospital Center

45. Economic Outcomes

46. CDTM Demonstration ResultsEconomic Impact

47. Patient Satisfaction Survey

48. CDTM Demonstration ResultsPatient Satisfaction Survey

49. CDTM Demonstration ResultsPatient Satisfaction Survey

50. Patient Satisfaction Comments