Implementation of an Ambulatory Pharmacy Program through Team-based Care

Introduction: Polypharmacy, medication costs, and physician burnout are complex issues at the forefront of American healthcare delivery.1-3 An Ambulatory Pharmacy Program (APP) can help as pharmacists are poised to assist with precisely these issues and remove barriers that providers and patient encounter when navigating the prescription drug market.4-5 This solution can be costly to initiate for already cash-strapped healthcare entities but with value-based, population health movement in full swing, it may not be out of reach. A Medicare demonstration project called CPC+ focuses on evolving primary care teams and encourages pharmacy integration. CPC+ enables infrastructural innovation through grant funding that created the APP.6 Method: The APP was designed to cover nearly 60 practices with three pharmacists. EMR workflows were designed to enable pharmacists to receive referrals directly from providers and nurse care coordinators. Clinical documentation mirrored the Pharmacy Quality Alliance’s (PQA) Medication Therapy Problem Categories Framework to streamline and standardize care delivery. The PQA focuses documentation on medication indication, effectiveness, safety, and adherence. Pharmacists readily use clinical and payer data to evaluate their impact using standardized metrics and payer reports. Initially, program success metrics were process-oriented but have since evolved to evaluate clinical quality outcomes. Results: APP measures include evaluations of process, interventions employed, and clinical outcomes, like Hemoglobin A1c trends in pharmacist-managed diabetics. Discussion: Pharmacists have been able to assist patients and providers through a variety of medication-related issues. Medication expertise, along with the ability to manage chronic disease states, are essential to reduce medication-related costs, and provide the most safe and effective medication therapy management to the patient.