这是一个经过轻微编辑的版本 突破 杂志.
假设你是一个糖尿病患者. 控制病情的关键是饮食, 锻炼, medication – and regular monitoring to keep your blood sugar in check.
在很多医疗实践中, a doctor or other medical provider may see you every three to six months to determine whether medication modifications are needed. 但是在首都地区的社区护理医生, 你每个月都要和供应商沟通, and medication may be adjusted as frequently as every two to four weeks, 保持血糖水平在更理想的水平.
In a pioneering model that is making an important impact on the management of diabetes and other chronic diseases, 提供者将是一名药剂师.
Through an arrangement that 奥尔巴尼药学与健康科学学院 helped launch in 2015, 初级保健实践 has integrated pharmacists into patient care. 截至2023年4月，中共有8个.有5名相当于全职药剂师的工作人员.
这种模式给病人带来了好处, 初级保健实践, 保险公司和ACPHS, which shares a pharmacist with CCP and sends students and residents through the medical practice for training. It’s also good for the practice of pharmacy: pharmacists work to the full extent of their training, engaged in patient care in collaboration with medical providers.
“最终，这是整个社区的胜利。. Lou Snitkoff, the retired chief medical officer CapitalCare Medical Group and later CCP.
Dr. Snitkoff launched the integration of pharmacists into CapitalCare, with ACPHS Associate Professor Alexandra Watson ‘14 (pictured above, 右)是第一批加入实践的人. 两人相遇时，Dr. 沃森当时正在塞缪尔S. Stratton Department of Veterans Affairs Medical Center in Albany. Dr. Snitkoff, the husband of then-ACPHS Associate Professor Gail Goodman-Snitkoff, understood that “pharmacists were educated to do more than count pills” – that they were experts in medications who could counsel patients.
当时，奥巴马博士. Snitkoff was charged with determining how CapitalCare could succeed in light of an emerging change in payments from health insurers. 特别是在初级保健方面, a prominent Capital Region health insurer was moving away from paying the practice for each service provided toward “global” payments, in which the practice received a set fee for providing all the care to the insurer’s members. Under the new arrangement with Capital District Physicians’ Health Plan, Inc. (CDPHP), CapitalCare earned more money if it kept patients healthier and limited unnecessary treatments.
Dr. Snitkoff saw the value of bringing pharmacists into the fold to help manage the health of people with chronic diseases, 所以他们不会生病，也不会需要昂贵的治疗. Dr. Watson was the second pharmacist to join the practice; CapitalCare shared her salary 50/50 with ACPHS, 她在药房实习系教书吗.
Dr. 沃森最初被安插在质量部门, where her role involved determining whether patients were on the right medications and improving adherence to medications through patient education. She also worked at two practice sites directly with medical providers and patients on medication management.
因为她不能直接为自己的服务买单. 沃森必须证明她的贡献包含了成本. She helped provide information on how quality of care could be improved at the organizational level, looking especially at tough-to-manage chronic diseases that affected many patients, 比如糖尿病和哮喘.
在一些供应商之间建立信任需要时间, 她说, 谁认为药剂师的角色是配药. 但她的价值变得如此明显，以至于在两年内, CapitalCare hired two additional pharmacists – embedded in care management rather than quality assurance, 观察高危人群.
与此同时，ACPHS的另一名校友. 麦肯齐·亚诺舍夫斯基(McKenzie Janoszewski)， 2005年，在CCP担任类似的职位. 当这两种做法合并后(中共的名称仍然保留). Janoszewski became director of clinical practice for the large combined medical group, 现在在该地区主导初级保健的是哪一种. She was able to show multiple benefits to patients and physicians of expanding the number of pharmacists in the group (see below). 他们建立了一个住院医师项目. 沃森和药剂师的角色.
Dr. 18岁的雷琳·帕西诺是布朗博士的学生. Watson’s at ACPHS who became a resident at CCP and was then hired to work at their Latham Medical Group office in July 2020. She works with interdisciplinary teams comprising physicians, 不是, 护士, 行为健康顾问, population health specialists and certified diabetes educators.
“My experience here has been rewarding and collaborative,” 她说.
Pharmacists’ contributions to such clinical teams are invaluable in light of an ongoing shortage of primary care providers, 博士指出. Darren Grabe, chair of the ACPHS Department of 药房实践. 事实上, when pharmacists help manage medication therapy and chronic disease as well as educate other health care providers and patients, then the other providers can spend more time with patients confronting serious illnesses.
“他们正在与患者进行沟通. 他们在做解释. 这有助于我腾出时间来处理其他火灾. Cindy Chan, a board-certified internist at CCP (pictured above, left).
转型的驱动因素之一, 健康保险公司, has been pleased with the integration of pharmacists into CCP’s practice.
艾琳·伍德说, executive vice president and chief pharmacy officer at CDPHP, “我们喜欢它。, 因为这会让他们更成功, 哪个能让病人更健康, 减少了可避免的成本.”
初级保健药剂师取得成果
The benefits of having pharmacists help manage patients with chronic diseases at CCP have included:
- A reduction in tests of blood sugar levels for patients with diabetes
- Use of lower-cost medications with the same outcomes decreased expenses
- Decreased medication-related hospital admissions through the identification of potential drug interactions
- Decreased hospital readmissions due to medication reconciliation when patients are released from a hospital to home
- Doctors are able to see more patients because of the reduced time spent on drug-related questions
- 医生可以实时了解新药的最新情况, 改变所涵盖的处方和免疫做法
来源:博士. McKenzie Janowszewski, director of clinical services, Community Care Physicians