Eyes and ears: how Pharmacy helps whole populations and stays focused on individuals

A patient was recently discharged from the hospital, where they started insulin. The pharmacist called the patient at home to check on them and ask how they were dosing their medication.???

While the discharge notes showed they’d been taught how to dose their medication when their blood sugars were elevated, the patient told the pharmacist, “I Googled it.”?

The pharmacist knew too much or too little of this high-risk medication could lead to serious side effects and provided education on how to dose the insulin based on the provider's instruction.?

The pharmacist sent a note to the provider explaining there was confusion and recommended reinforcing how to administer and dose the insulin at the next visit to make sure the patient was continuing the dosing plan provided by the provider and not Google.?

The outreach potentially prevented the patient from returning to the hospital and may have even saved a life.?

“Proactive care includes anything we can do to prevent someone from needing a higher level of care or developing complications that require additional resources to treat or care for them,” said Jeff Olson, director of Pharmacy Population Health.??

The Pharmacy Population Health team trains their eyes and ears to keep people and communities healthy.?

What is population health??

“Population health references the health status of a group or a population, rather than just a single individual,” Jeff said. “We look at how we can impact a whole group to improve their health performance and outcomes.”?

The Pharmacy team tracks certain measures in populations to know where and when they need to reach out. One example is medication adherence. This refers to the degree to which a patient correctly takes their prescribed medication. Adherence is measured when patients fill their prescriptions in the pharmacy.?

The Population Health team can look at different groups to see if medications are being filled regularly.?They can also identify individuals who are late to refill and address barriers that exist to taking their medications. Ultimately, this improves effectiveness of treatments, prevents disease progression, and avoids complications and worsening of health conditions.??

Pharmacy care teams also keep an eye on at-risk populations. When individuals in these groups are discharged from the hospital, pharmacy caregivers reach out to make sure the patients received and understand their medications. They also make assessments and recommendations to help prevent hospital readmissions or complications.?

“Let's take care of them at home, where they're more comfortable and able to have a higher standard of living, and it's less expensive,” Jeff said.?

Pharmacy as a resource for proactive care?

Pharmacists check medication lists behind the scenes so physicians can spend time on what they’ve been specifically trained to do.??

“We're part of the team to help the physician,” said Billie McCracken, clinical pharmacist on the Ambulatory Pharmacy Telehealth team. “We identify gaps, interactions, problems with medication side effects, and affordability. This helps the physician and patient in the transition from hospital to home and makes sure the patient doesn’t end up back in the hospital for one of those reasons.”?

Outreach to help individuals overcome barriers?

Like nurse care managers, Pharmacy care team members also do outreach to help individuals succeed in their care plans. ??

“In my role, we're bringing pharmacy care to the patient’s home,” said Amy Stokes, clinical pharmacist on the Ambulatory Pharmacy Telehealth team. “We’re using the eyes of the nurse care manager doing a medication review with the patient and the ears of a pharmacy technician who is asking questions about specific medications. They gather information about what's happening in the home and bring it back to our Pharmacy team.”?

Recently, a nurse care manager from Castell House Calls was in a patient’s home with a pharmacy technician participating virtually.?

In the review afterwards, Amy saw the patient had a high cardiovascular risk with a history of stents placed in their heart. She knew they needed to be on an anti-platelet and a statin therapy and worked with the provider to get the patient on the appropriate medications.?

“I hope I can make an impact even if it’s from a distance by reviewing a chart and making a recommendation to a provider,” Amy said.?

She screens for preventive measures, cheaper alternatives, appropriate indications, proper doses, drug interactions, medication safety, duplications of therapy, drug monitoring, labs that are due, and opportunities to deprescribe. As she reviews, she likes to think of each patient as an individual, even as she would for someone in her own family.?

“I'm able to meet patients where they are and ask, ‘What could I change about their medications to make their lives better?’” Amy said.?

In a home visit, the care manager looks at the medication bottles. The pharmacy tech on the phone compares that list with the medication list in the patient’s medical record to reveal barriers the Pharmacy team can help with.??

“If there's anything left over on the medication list they didn’t mention, I ask them, ‘Are you on this medication?’” said Cortnee Turner, a pharmacy technician.??

If an individual can no longer manage organizing their medications on their own, the team can offer bubble packing and home delivery for medications.??

“Adherence with the medications improves significantly with bubble packs,” said Shaylyn Thao, a pharmacy technician. “They see each pill clearly, how they're supposed to take it, what time to take it, and if they need to take it multiple times a day.”?

Pharmacy technicians also identify and address cost barriers, which can be helped through coupons and the Intermountain Medication Assistance Program (IMAP).?

Hali Chea, a pharmacy technician, said human connection helps a patient follow through with care. “We may not see them but talking with them about their medications can affect the outcome,” she said. “Medication reviews aren’t huge, but they’re impactful.”?

Pharmacy teams act as eyes and ears, providing proactive care to individuals, while also improving the health of complex populations. They're making connections that help people live their healthiest lives possible.??