Freeing up physician time
Within each practice, the pharmacist’s roles will vary somewhat, depending on the clinic’s specific needs and patient panel.
Pharmacists can help with insulin treatment, virtual consults and diabetes management, said Lori Gluck, MD, a family physician who is medical director of the group’s clinic Bethany, Oregon. Other roles include follow-up visits for hypertension and depression, new medication starts, medication tapering including opiates, and review of polypharmacy issues in elderly patients.
“Our pharmacist follows most of our patients with diabetes whose disease is not under control. She helps with insulin management and titration, and medication management in general for diabetes patients,” said Dr. Gluck. “She [also] helps at our care conferences and presents topics at our clinic meetings. She is invaluable. We all love having her.”
Physicians can also refer to pharmacists to answer patient calls or emails about medication-related questions. This helps to free up time for the physician who might require added time to look up answers.
Pharmacist at your fingertips
The largest population seen by pharmacists at this medical group is patients with diabetes, said Kristy Butler, PharmD, manager of clinical pharmacy specialists in the clinical pharmacy department at Providence Medical Group. Pharmacists will work closely with patients and will often take the time to call patients every week if their diabetes is in poor control.
“It is interesting because we try to get our poorly controlled patients with diabetes to the behaviorist, but they are often more receptive to seeing the pharmacist first,” said Dr. Satterfield. “After some work with [the pharmacist], we can get them to the behaviorist if they are still resistant.”
For example, her practice was struggling with a patient for years and could not get her hemoglobin A1c below 11 percent. The patient’s illiteracy posed a barrier to care. To help, the pharmacist created medication lists and diabetes tools with pictures. Within six months of working with the pharmacist, the patient’s levels were in control.
And in Dr. Gluck’s office, the pharmacist has also been “tremendous” with difficult diabetes patients and insulin management. The pharmacist will perform challenging medication adjustments, which has made a big difference for patients with type 2 diabetes who need help with insulin.
“I feel very strongly that [pharmacists] are an integral part of the team,” she said. “Once you practice with a clinical pharmacist at your fingertips, I can’t imagine not having that service.”
The AMA’s STEPS Forward™ collection offers free online modules that help physicians and system leaders improve well-being, including learning about the organizational changes that lead to physician satisfaction and improving resiliency.
Several modules have been developed from the generous grant funding of the federal Transforming Clinical Practices Initiative (TCPI), an effort designed to help clinicians achieve large-scale health transformation through TCPI’s Practice Transformation Networks.
The AMA, in collaboration with TCPI, is providing technical assistance and peer-level support by way of STEPS Forward resources to enrolled practices. The AMA is also engaging the national physician community in health care transformation through network projects, change packages, success stories and training modules.