ASHP InterSections ASHP InterSections

December 20, 2011

ASHP State Affiliates Taking PPMI to the Next Level

Above, MSHP President Denise M. Pratt, Pharm.D., leads a group in a PPMI discussion.

The 2010 Pharmacy Practice Model Initiative (PPMI ) Summit set the stage for sweeping changes in clinical pharmacy practice and created a framework designed to ensure that pharmacists become the health care professionals who are responsible and accountable for patients’ medication outcomes.

The PPMI’s message and goals, however, will amount to little unless its specific recommendations are embodied by concrete and lasting actions at the hospital level. In several states, ASHP affiliates have partnered closely with the practitioners they represent and health systems to get PPMI initiatives rolling.

Bringing PPMI into Focus
“By engaging hospitals through state affiliates, we have the potential to drive the PPMI from concepts and ideals to results,” said Chris Decker, executive vice president and CEO of the Pharmacy Society of Wisconsin (PSW). “At PSW specifically, we’re working to bring visibility for the PPMI to all Wisconsin hospitals.”

With the assistance of the PSW, about 70 percent of the state’s hospitals, representing 82 percent of its hospital beds, have already completed ASHP’s new Hospital Self-Assessment (HSA) tool. The web-based HSA, a direct outcome of the PPMI Summit, contains 106 questions designed to gauge a hospital’s adoption of PPMI recommendations at the hospital level. Hospitals can use the results to generate reports comparing their data with aggregated data collected from similar hospitals within their state.

PSW’s support was a major reason for the high response rate, said Steven S. Rough, M.S., R.Ph., director of pharmacy at the University of Wisconsin Hospital and Clinics (UWHC) in Madison, Wis. “Having our state pharmacy organization committed to providing resources was key to getting so many hospitals to participate,” he said. PSW worked with hospital leaders and PGY-2 pharmacy administrative residents at UWHC, Froedtert Hospital and Aurora Health Care to help ASHP develop the survey by acting as test sites and providing feedback that was incorporated into the final version.

PSW also provided direction and support when it hosted its first statewide PPMI discussion forum last spring, which included about 50 pharmacy leaders and stakeholders from hospitals around Wisconsin. PSW held a second forum in August with over twice the number of participants and from approximately half the hospitals in the state. The organization plans to hold a similar forum twice each year and intends to use the PPMI plan to focus the organization’s educational and practice development efforts.

Finding Practice Gaps
“After the national PPMI summit, we had engaged pharmacists and technicians who wanted to act,” Rough said. “PSW helped us succeed by putting together the educational programming, finding speakers and advocating for hospitals to complete the HSA. PSW created a hub for people to meet, create agendas and communicate with other interested stakeholders throughout the state.”

PSW also assembled a PPMI project task force, which has been drilling into the aggregate HSA results to determine where the greatest practice gaps are and using the information to develop tools that hospitals can use to close those gaps and move closer to conforming with the major tenets of the PPMI.

“We’ll be able to look at composite HSA data for the state and use it as a benchmark to determine which areas of practice development pharmacy directors consider of greatest importance [in Wisconsin],” said Decker. “We can use that information to tailor our educational programs and to help members advance particular recommendations. Education will be a big part of this effort.”

Creating an Action Plan
Also inspired by the national PPMI summit, the Michigan Society of Health-System Pharmacists (MSHP) held its statewide summit in September. “As a state association, we felt we could facilitate some of the recommended changes to the current practice model of pharmacy, and help move pharmacists in our state forward,” said Denise M. Pratt, Pharm.D., a critical care clinical pharmacist at Sparrow Hospital in Lansing, Mich., and current MSHP president.

The MSHP developed a PPMI task force to develop a five-year strategic plan in collaboration with the next MSHP president. Embedding PPMI-related actions into the strategic goals of the state affiliate is novel, but Pratt believes it is necessary for successfully realizing PPMI ideals.

“This approach will move us in a direction where the state society can provide more benefits to its members and achieve one of the PPMI’s overall goals of moving more clinical pharmacists away from distributive work into the front lines of patient care—and also, we hope, increase our membership as a result,” she said.

As the Wisconsin society has done, the MSHP plans to use the HSA to determine the aggregate progress of hospitals toward PPMI goals. “We hope we can be a model for other state societies that haven’t yet started pushing the PPMI model in their states,” said Pratt. About a third of Michigan’s hospitals have completed the HSA, though the MSHP is working for a much higher return.

Decker emphasized that the real value of the HSA won’t come from simply completing the self-assessment tool, but from developing a detailed, hospital-specific action plan. The planning tool is available through the PPMI website after the HSA is submitted.

“We’re recommending that hospitals complete both the survey and the action list right away,” said Decker. “The PPMI recommendations and objectives don’t have much value if there’s not a plan of action to implement them.”

Decker pointed out that PPMI is not just for hospital pharmacy directors. “Every PPMI action plan will have information for use by clinicians, not just management,” he said. “After all, PPMI is all about pharmacy practice development.”

December 18, 2009

Bridging the Continuity-of-Care Gap

Elaine Ladd cuts the ribbon at the grand opening of the Ladd Family Pharmacy, the only independent ambulatory care pharmacy in Boise, Idaho.

ELAINE LADD, Pharm.D., BCPS, is a busy woman.

As a clinical pharmacy specialist at Saint Alphonsus Regional Medical Center in Boise, Idaho, Ladd rounds with fellow healthcare professionals as part of a medical team.

As a clinical assistant professor of pharmacy practice at Idaho State University (ISU) College of Pharmacy, she educates students on therapeutic options.

And, as owner of Ladd Family Pharmacy, the only independent ambulatory care pharmacy in Boise, she provides medication therapy management (MTM) services to her patients.

Ladd has discovered professional success along the continuum of care.

Educating, Empowering Patients

By counseling patients in both the hospital and in her pharmacy, the new practitioner said she is more effective in ensuring that patients receive the proper medication therapies and that they are educated about the medicines they take.

“My staff and I are cheerleaders, educating patients and empowering them to take control of their disease states,” Ladd said. “It’s a family here, and we want patients to know that we care.”

Ladd Family Pharmacy offers an on-site MTM clinic, compounding services, home delivery of prescriptions by bicycle couriers, and free exercise classes.

Ladd’s mentor of several years, ASHP President Kevin J. Colgan, M.A., FASHP, strongly supports her uncommon endeavor, which he believes provides distinct services to optimize patients’ therapeutic outcomes.

“I think the clincher for me is that Elaine is using this pharmacy to develop sustainable patient programs,” he said. “I think we all can learn a great deal from Elaine’s approach to patient care.”

MTM Clinic a Success

Ladd’s MTM clinic has been a particular success. Customers are asked to schedule a free consultation at the clinic if they take more than two medications for a condition, were prescribed eight medications in a three-month period, or spend more than $4,000 a year on medications.

Staff pharmacists review the patients’ medication histories, screen for needed vaccinations, inquire about drug interactions, monitor medication use, and administer medicines.

The pharmacy also offers rotations for ISU pharmacy students, who learn about compounding, disease management, and other topics. In July, the pharmacy plans to host its first pharmacy resident. Ladd plans to introduce additional MTM clinics for diabetes, hypertension, and lipidemia.

Improving Health with Exercise, Education

Upstairs, customers stretch during free yoga and Pilates classes or attend educational seminars on managing diabetes and weight loss. Nurse practitioners and ISU students conduct health fairs on smoking cessation, heartburn awareness, diabetes, and skincare
screenings. Down the hall, Ladd’s husband, Kip, works in the office as the pharmacy’s business manager.

Patients from Saint Alphonsus Regional Medical Center, where Elaine Ladd works as a clinical specialist, often come to her MTM clinic for follow-up medication counseling.

Staff at the college are impressed with Ladd’s operation.

“There is an urgent need for pharmacist-provided MTM in Boise,” said Barb Mason, Pharm.D., FASHP, professor and chair of the

ISU College of Pharmacy Department of Pharmacy Practice. “Elaine’s sincere passion for patient-centered care and desire to work collaboratively with physicians is sure to bring her success in any endeavor she pursues.”

So far, Ladd’s unique approach is working. The pharmacy has only been open six months, but pharmacists already fill an average of 80 prescriptions on weekdays. And those numbers are trending upward.

Ladd believes that the unique pharmacy services offered by her four pharmacists and six pharmacy technicians are a real benefit to patients. And she is interested in seeing more integration in patient-care services among hospitals and ambulatory care settings as technology improves.

“Every step along the continuity of care matters, and pharmacists are uniquely suited to provide the kind of MTM services that patients need,” she said. “I’m excited to be able to bridge both worlds.”

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