Rating: 1 Star2 Stars3 Stars4 Stars5 Stars
Loading...
A3 Collaborative Elevates Diabetes Care in Rural Appalachia

Feb 13, 2019

Amy Westmoreland, Pharm.D., BCGP, counsels a patient about her medications.

Amy Westmoreland, Pharm.D., BCGP, Pharmacy Manager and Clinical Pharmacist at Carilion Giles Community Hospital, has a frontline view of the challenges of diabetes management. For years she wondered if there was a way for her and the other pharmacists at the hospital to provide services to patients beyond filling lifesaving prescriptions. Many of the patients admitted to the 25-bed facility in rural Appalachia were there due to lack of adherence to a diabetes medication regimen.

“Many of my patients didn’t understand all of the complexities involved in taking care of their diabetes, and that could spell disaster once they were discharged from the hospital,” explained Dr. Westmoreland. She noticed that some patients weren’t entirely sure how to monitor their blood sugar, and others had only a vague idea of what they should and should not eat. Many were resistant to any sort of dietary education, or those interventions proved to be ineffective.

A3 Collaborative
About a year ago, Dr. Westmoreland heard about a unique program known as the A3 Collaborative. The collaborative is made up of three organizations – ASHP, Apexus, and AIMM (Alliance for Integrated Medication Management). Its purpose is to help healthcare providers and organizations step in to and succeed in the new era of value-based payment models. The A3 Collaborative provides funding to hospitals that would like to bolster the role pharmacists play in value-based patient care.

Dr. Westmoreland (right), collaborates with case manager Jody Janney, R.N., medical social worker Drema Gautier, Mariana Gomez De La Espriella, M.D., and hospitalist Stephanie Boggs, Pharm.D.

Through Dr. Westmoreland’s efforts, Carilion became a member of the A3 Collaborative and was the recipient of 12 months of guidance and leadership from ASHP, Apexus, and AIMM. The comprehensive medication management program she and her colleagues created with help from the collaborative is simple, but it’s already delivering significant results. Carilion’s new value-based patient care model allows diabetes patients more access to their pharmacist in the days, weeks, and months after discharge.

“Our patients are really happy that they have someone they can turn to, someone they can call and help them understand their illness better,” said Dr. Westmoreland. There have been times when she met patients who were on 30 different medications and they needed someone who could help them understand their diabetes management plan.

Postdischarge Counseling
Dr. Westmoreland and her colleagues started the program in July 2018, and they are currently following 22 patients after discharge. Before the patient is discharged, Dr. Westmoreland and her colleagues meet with the patient. They review their medication list and determine what information and help they may need after they’re discharged from the hospital and moved to ambulatory care.

Before discharge from the hospital, the attending pharmacist will ask the patient if they’d like a follow up phone call from a pharmacist to answer any lingering questions. The pharmacist also provides their information and phone number so the patient can contact them during business hours.

If a patient opts into the medication management program, then the pharmacist coach will call to follow up at 10 days, 20 days, a month, and two months after discharge. After that, calls are made once a month. During each call, a pharmacist ask a specific list of questions:

  • Are you able to afford your medication?
  • Are you taking your meds as prescribed?
  • How often do you check your blood sugar?
  • What is the range of your blood sugar ratings? Are you keeping a log?
  • Are you having any side effects such as low blood sugar occurrences?

Although the program is still relatively new, Dr. Westmoreland and her colleagues have already identified a number of medication-related problems such as duplication errors. They found, for example, that one patient was unnecessarily taking two different forms of thyroid replacement therapy. She’s observed other concerning trends as well: Many patients don’t understand the difference between long-acting insulin and short-acting insulin. Some patients are unclear how — and when — to test their blood sugar, or why it is important that a patient log this information for their doctor to review at follow-up appointments.

“Taking the time that is required to effectively review a medication list is time-consuming,” said Dr. Westmoreland. “That’s where a pharmacist has the skill set to come in and effectively look at the medications and provide recommendations for eliminating some drugs that may not be necessary, or optimize doses to make things better for the patient.”

Amy Westmoreland, Pharm.D., BCGP

Closing the Care Gap
Dr. Westmoreland said the program also addresses the disconnect that often exists between specialists and a primary care physician, especially when a patient’s doctors are not all contained in one facility — meaning there may be more than one electronic medical system where the patient’s records are kept.

“There’s a huge gap in care, in my opinion, without having the pharmacist on the care team for every patient,” said Dr. Westmoreland. “I think we’re at a crossroads in healthcare with having the pharmacist on the care team. Pharmacists have a unique knowledge of the medications, and they understand what a normal dose would be and what an exorbitant dose would be. They could look at a prescription and realize something is off or not correct, whereas nurses and doctors may not be looking at the medication lists in the way that pharmacists do.”

A3 Adds Value
Melanie Smith, Pharm.D., BCACP, DPLA, Director of ASHP’s Section of Ambulatory Care Practitioners, serves as a staff liaison for the A3 Collaborative. She noted that the collaborative allows ASHP members to test out great ideas that could help keep patients out of the hospital. “Many of our members are being tasked with setting up a clinic or setting up a service in an ambulatory care setting,” said Dr. Smith. “Participating in a program like the A3 Collaborative provides them with essential coaching and mentoring, and helps provide a foundation and the bridge they need to transition the clinical practice from inpatient to outpatient.”

Dr. Westmoreland, for her part, hopes the success of the program will demonstrate the value of adding pharmacists to patient-care teams. “We’re trying to be very proactive before the point of discharge.” It’s important, she said, for patients to have someone they can turn to when their diabetes management becomes overwhelming, or they can’t afford their prescriptions, or their doctor is not readily available to answer questions. “I would like others to see there’s enough value in this program for it to be expanded across the system and across the nation.”

 

By Jessica Firger

 

# # #

Print Friendly, PDF & Email
(Visited 3588 times, 0 visits today)
Feature Stories

About the author

The author didnt add any Information to his profile yet