Transcript Centralized Prescription Fulfillment

EPIC – a Chronic Disease
Management Initiative in BC
Barbara Ogle, BSc(Pharm), ACPR, MScPhm, RPh
VP Clinical Services, Network Healthcare
May 31, 2007
Network Healthcare
 Network Healthcare
• A health services company that supports the
development & delivery of health care
through sophisticated networks of clinical
professionals.
 Pharmacist Network
• A service delivery arm of Network
Healthcare that utilizes pharmacists to deliver
care to patients.
CURRENT HEALTH SYSTEM
Health Care Organization
Community
Resources &
Policies
No links to
community
agencies or
resources
•Concern about the bottom line
•Incentives favor more frequent, shorter visits
•No organized QI
Clinical
SelfManagement
System
Support
Design
•Not systematic
•Reliance
•Didactic
on short,
unplanned
visits
Uninformed,
Passive
Patient/
Caregivers
Decision
Support
•No
agreement on
good care
•Traditional
referrals
Frustrating
Problem-Centered
Interactions
Information
Systems
•Don’t know
patient or
their needs
Unprepared
Practice Team
Sub-optimal
Functional and Clinical Outcomes
Chronic Disease Management
in British Columbia
 > 50% of BC health care budget goes to
the 10% of people with chronic diseases
 Ministry of Health’s response
• Adopted the Expanded Chronic Care
Model and Patient Self-Management
• Used Primary Health Care Transition
Funds for strategic initiatives focused on
high-risk, high-cost CDM patients
Expanded Chronic Care Model
EPIC
Empowering Patients through
Integrative Care
Business Need
 Expand the primary care team where
gaps exist (pharmacist)
 Increase system capacity to meet
periodic needs of patients for more
intense support
 Increase access to timely support
between appointments and where rural
or individual barriers to service exist
Goal
 To develop and evaluate the feasibility
of a telehealth model for pharmacists to
provide self-management and
medication management support to
people with diabetes or heart failure in
collaboration with primary healthcare
teams.
Objectives
 Increase patient self-efficacy and selfmanagement with medications
 Improve attainment of desired drug
therapy outcomes
 Improve medication safety
Pharmacist Intervention
 Community pharmacist as virtual member of
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health team
Provide telehealth coaching, information and selfmanagement support for up to 6 weeks
Identify, prevent and/or manage potential and
actual drug-related problems
Provide clinical decision support to the family
physician and primary healthcare team
Facilitate transition to community resources (e.g.,
community pharmacist, local groups)
Project Details
 Timeline
• Planning 2004
• Pilot Testing 2005
• Data Collection 2005 – 2006
 Team
• BC Ministry of Health
• BC NurseLine
• Pharmacist Network BC
• University of Victoria – Centre on Aging
• Fraser Health Authority
• Northern Health Authority
Patient Findings (n = 201)
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Learned self-management skills
Resolved drug-related problems
Became more engaged in their own care
Improved health status
Liked having telehealth in their own
home, interpreters and flexible times
 Regular follow-up kept patients focused
Physician Findings (n = 112)
 Collaborative interactions observed
 Electronic lab data accessed for some
 Telehealth was economical, scalable, and
sustainable
 Follow-up extended beyond practice
• Focus on patient self-management filled
existing care gap
Other Research
 Impact of medication therapy
discontinuation on mortality after MI
• Endpoints: use of aspirin, β blockers and
statins at 1 month; mortality @ 12 months
• >33% had stopped one or more medications
• 12.1% had stopped all three
• Poorer 1-year survival than those persisting
88.5% vs 97.7%, p<0.001
• Risk factors include age and education
PM Ho et al. Arch Intern Med 2006;166:1842-1847.
Other Research
 Drug-related hospitalizations in a tertiary
care internal medicine service
• n=565 adult patients admitted to hospital
• Drug-related 24.1% (95% CI 20.6-27.8%)
– Adverse drug reactions 35.3%
– Improper drug selection 17.6%
– Noncompliance 16.2%
• Majority of cases were preventable
• 72.1% (95% CI 63.7-79.4%)
Samoy LJ et al. Pharmacotherapy 2006;26:1578-86.
Other Research
 Effectiveness of telephone counselling by a
pharmacist in reducing mortality in patients
receiving polypharmacy
•
•
•
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RCT, n=502 non-compliant pts
6-8 telephone calls between visits
Polypharmacy = 5 or more medications
Endpoint: all-cause mortality in 2 years
• ARR 6% (17% control vs 11% intervention)
• RRR 41% (95% CI 0.35-0.97, p=0.039)
• NNT to prevent 1 death = 16
JYF Wu. BMJ 2006;333:522, doi:10.1136/bmj.38905.447118.2F
Compared to…
 Statin therapy
• Based on 2003 Canadian guidelines
• NNT to prevent 1 death due to CHD over 5
years for high risk* Canadians is 98
• Canadian statin market = $1.4B
*10-year risk of CHD ≥ 20%, or
history of CVD or diabetes with age > 30 yrs
Going Forward
 BC
 Alberta
 Service Development
• SAFERx (real world safety & effectiveness)
• Seamless Medication Care
• Chronic Disease Management (medication
management and self-management support)
• Medication Reviews and Assessments
• Emergency Preparedness
The ‘Innovation’ Challenge
Contact Information
Barbara Gobis Ogle,
Vice President, Clinical Services
Network Healthcare
[email protected]
604-231-3245