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Pharmacist impact on patient activation—a key to success
DEPARTMENTS Journal of the American Pharmacists Association 57 (2017) 555e556
Contents lists available at ScienceDirect
Journal of the American Pharmacists Association journal homepage: www.japha.org
SCIENCE UPDATES
Pharmacist impact on patient activationda key to success Patrick G. Clay
Hypertension, smoking, and patient engagement in their own care are all long-standing challenges to address in patients that present overlapping and distinct barriers. As is clear from the existing literature, sole reliance on primary care physicians and office-based approaches to improve these outcomes fail to achieve desired goals.1-3 As an engaged and highly qualified member of the health care teamdregardless of the acceptance of this fact in your own practice environmentdhelp your colleagues to realize the impact that formally utilizing pharmacists can have on patient activation, the key to successful outcomes. Hypertension, despite highly effective therapies, stubbornly remains uncontrolled in more than 80 million adults in the United States, or about 50% of those with the diagnosis.1 Well described key contributing factors of lack of medication optimization, ownership of outcomes by patients, and health literacy were sought to be addressed through a “non-physician” empowerment study. “Non-physician” in this case was a pharmacist. Targeting patients with 3 consecutive blood pressure readings above goal at primary care offices, physicians solicited these patients to engage with their pharmacist who would assess root causes for the lack of control and make changes accordingly. The primary tool used for blood pressure change was an ambulatory blood pressure monitor that connected to the patient’s smart phone. The 156 patients enrolled were compared with a matched cohort of 400 patients who only received care in the primary care offices, and results were compared after 90 days. Control was obtained in 71% of patients in the pharmacist engagement arm compared
with 31% in routine care (P < 0.001). The intervention was noted by the physician-onlyeauthored publication to address a key element to successful disease outcomesdpatient activationdcompared with the control group (P < 0.03). The authors noted that with improved activation of the patient, likelihood of improvement increases across all diseases present. Direct engagement with patients recently prescribed smoking cessation therapy by pharmacists via telephonebased sessions proved once again to be superior to routine care (2). A large (n ¼ 1017) randomized prospective trial compared smoking abstinence in patients receiving 3 telephone calls from pharmacists versus usual care found significant improvement in the intervention group. Specifically, more patients in the intervention group completed the 12-week program (P < 0.001), were more adherent to their medications (P < 0.033), were more likely to have not smoked in the past week (P < 0.001) or 4 weeks (P < 0.013), and 93% responded as either extremely or well satisfied with the program. This degree of satisfaction aligns well with patient activation levels and may be predictive of permanent change in patient behavior across all conditions.
Finally, the Centers for Medicare and Medicaid Services (CMS) require plans to offer comprehensive medication therapy management services to eligible beneficiaries.3 Recently, quality measures have begun to be applied to these services, with proportion of comprehensive medical reviews completed being prominent in the score. Thus, regardless of how amazing the service may be, if the patient fails to accept, the quality score will be reduced. To address acceptance by the eligible beneficiaries (translation: enhanced patient activation), an improved “pitch” was implemented in a large (n ¼ 105,701) program. Simply changing the pitch improved likelihood of acceptance 1.58-fold. Noteworthy is the acceptance improvement by those at greatest risk for untoward outcomes (more medications, conditions, and lack of previous involvement). Consider how these examples of enhancing patient activation may improve outcomes in the patients you serve, their other health care team members, and the community. Now, begin the conversations. References 1. Milani RV, Lavie CJ, Bober RM, et al. Improving hypertension control and patient engagement using digital tools. Am J Med. 2017;130:14e20.
The Science Updates column highlights research published in journals other than JAPhA that is of interest to the Journal's readership. APhA members who have published research are encouraged to forward the PubMed citation, or an electronic version of their article, as soon as they appear or ahead of print, to Contributing Editor Patrick G. Clay, PharmD, AAHIVP, CPI, FCCP at [email protected].
http://dx.doi.org/10.1016/j.japh.2017.06.015 1544-3191/© 2017 Published by Elsevier Inc. on behalf of the American Pharmacists Association.
DEPARTMENTS P.G. Clay / Journal of the American Pharmacists Association 57 (2017) 555e556
2. Gong J, Baker CL, Zou KH, et al. A pragmatic randomized trial comparing telephone-based enhanced pharmacy care and usual care to support smoking cessation. J Manag Care Pharm. 2016;12:1417e1425.
556
3. Miguel A, Hall A, Liu W, et al. Improving comprehensive medication review acceptance by using a standardized recruitment script: a randomized, controlled trial. J Manag Care Pharm. 2017;23:13e21.
Patrick G. Clay, PharmD, AAHIVP, FCCP, CCTI, Professor of Pharmacotherapy, College of Pharmacy, University of North Texas System, Fort Worth, TX; and APhA Science Officer
Contents lists available at ScienceDirect
Journal of the American Pharmacists Association journal homepage: www.japha.org
SCIENCE UPDATES
Pharmacist impact on patient activationda key to success Patrick G. Clay
Hypertension, smoking, and patient engagement in their own care are all long-standing challenges to address in patients that present overlapping and distinct barriers. As is clear from the existing literature, sole reliance on primary care physicians and office-based approaches to improve these outcomes fail to achieve desired goals.1-3 As an engaged and highly qualified member of the health care teamdregardless of the acceptance of this fact in your own practice environmentdhelp your colleagues to realize the impact that formally utilizing pharmacists can have on patient activation, the key to successful outcomes. Hypertension, despite highly effective therapies, stubbornly remains uncontrolled in more than 80 million adults in the United States, or about 50% of those with the diagnosis.1 Well described key contributing factors of lack of medication optimization, ownership of outcomes by patients, and health literacy were sought to be addressed through a “non-physician” empowerment study. “Non-physician” in this case was a pharmacist. Targeting patients with 3 consecutive blood pressure readings above goal at primary care offices, physicians solicited these patients to engage with their pharmacist who would assess root causes for the lack of control and make changes accordingly. The primary tool used for blood pressure change was an ambulatory blood pressure monitor that connected to the patient’s smart phone. The 156 patients enrolled were compared with a matched cohort of 400 patients who only received care in the primary care offices, and results were compared after 90 days. Control was obtained in 71% of patients in the pharmacist engagement arm compared
with 31% in routine care (P < 0.001). The intervention was noted by the physician-onlyeauthored publication to address a key element to successful disease outcomesdpatient activationdcompared with the control group (P < 0.03). The authors noted that with improved activation of the patient, likelihood of improvement increases across all diseases present. Direct engagement with patients recently prescribed smoking cessation therapy by pharmacists via telephonebased sessions proved once again to be superior to routine care (2). A large (n ¼ 1017) randomized prospective trial compared smoking abstinence in patients receiving 3 telephone calls from pharmacists versus usual care found significant improvement in the intervention group. Specifically, more patients in the intervention group completed the 12-week program (P < 0.001), were more adherent to their medications (P < 0.033), were more likely to have not smoked in the past week (P < 0.001) or 4 weeks (P < 0.013), and 93% responded as either extremely or well satisfied with the program. This degree of satisfaction aligns well with patient activation levels and may be predictive of permanent change in patient behavior across all conditions.
Finally, the Centers for Medicare and Medicaid Services (CMS) require plans to offer comprehensive medication therapy management services to eligible beneficiaries.3 Recently, quality measures have begun to be applied to these services, with proportion of comprehensive medical reviews completed being prominent in the score. Thus, regardless of how amazing the service may be, if the patient fails to accept, the quality score will be reduced. To address acceptance by the eligible beneficiaries (translation: enhanced patient activation), an improved “pitch” was implemented in a large (n ¼ 105,701) program. Simply changing the pitch improved likelihood of acceptance 1.58-fold. Noteworthy is the acceptance improvement by those at greatest risk for untoward outcomes (more medications, conditions, and lack of previous involvement). Consider how these examples of enhancing patient activation may improve outcomes in the patients you serve, their other health care team members, and the community. Now, begin the conversations. References 1. Milani RV, Lavie CJ, Bober RM, et al. Improving hypertension control and patient engagement using digital tools. Am J Med. 2017;130:14e20.
The Science Updates column highlights research published in journals other than JAPhA that is of interest to the Journal's readership. APhA members who have published research are encouraged to forward the PubMed citation, or an electronic version of their article, as soon as they appear or ahead of print, to Contributing Editor Patrick G. Clay, PharmD, AAHIVP, CPI, FCCP at [email protected].
http://dx.doi.org/10.1016/j.japh.2017.06.015 1544-3191/© 2017 Published by Elsevier Inc. on behalf of the American Pharmacists Association.
DEPARTMENTS P.G. Clay / Journal of the American Pharmacists Association 57 (2017) 555e556
2. Gong J, Baker CL, Zou KH, et al. A pragmatic randomized trial comparing telephone-based enhanced pharmacy care and usual care to support smoking cessation. J Manag Care Pharm. 2016;12:1417e1425.
556
3. Miguel A, Hall A, Liu W, et al. Improving comprehensive medication review acceptance by using a standardized recruitment script: a randomized, controlled trial. J Manag Care Pharm. 2017;23:13e21.
Patrick G. Clay, PharmD, AAHIVP, FCCP, CCTI, Professor of Pharmacotherapy, College of Pharmacy, University of North Texas System, Fort Worth, TX; and APhA Science Officer