The Carolinas Center for Medical Excellence (CCME) and the Health Resources and Services Administration’s (HRSA) Office of Pharmacy Affairs have joined forces to decrease adverse drug events and improve outcomes in the Medicare population. Through the Patient Safety and Clinical Pharmacy Services Collaborative (PSPC), a national effort sponsored by the HRSA Office of Pharmacy Affairs, CCME is recruiting and assisting community teams in tracking improvement in health status and safety measures in real time. PSPC’s goal is to improve the quality of health care by incorporating clinical pharmacy services into the interdisciplinary management of the most high-risk patients. PSPC interventions may include the management of diabetes, anticoagulation therapy, and/or antipsychotic medication therapy. 

Piedmont Health Services has been a participant in the PSPC collaborative for the past three years. CCME, a new partner, has focused its efforts on the Charles Drew Community Health Center (CHC) in Burlington, NC. CCME is North Carolina’s Quality Improvement Organization (QIO), and there are a myriad of benefits to working with the QIO. The benefits include help in streamlining data collection, assistance in electronic medical record (EMR) integration, and support to increase the capacity of patients who can be served within the collaborative at Charles Drew CHC, as well as the other sites within Piedmont Health Services. Rachel Selinger, PharmD, pharmacy manager, and Sallie Patel, MD, MPH, physician champion, are in charge of the PSPC work. Dr. Selinger takes on a dual role as both a dispensing pharmacist and a clinical pharmacist. 

“My goal with this project was to demonstrate the impact my daily interventions had on measurable patient outcomes and quality of care,” said Dr. Selinger. 

With the help of a physician liaison, she is tracking a cohort of patients with type 2 diabetes who have an HbA1c greater than 9 percent. For most patients with diabetes, the HbA1c goal is less than 7 percent. The primary outcome tracked at Charles Drew CHC for this project is the percent of patients whose HbA1c is reduced to less than 9 percent. Through the experience gained from this test population, Dr. Selinger hopes to refine techniques for data collection and streamline the workflow so that this initiative will be expanded to the six other community health centers within the Piedmont Health Services network. 

Dr. Patel is a strong supporter of an interdisciplinary approach to primary care, relying often on the support services offered at Charles Drew CHC through the pharmacists, nutritionists, care managers, Medicaid workers, and administrative support she works with every day. For Drs. Patel and Selinger, tracking health outcomes for the PSPC is a natural extension of the interdisciplinary patient care services they already provide in their daily practices. In each year of the collaborative, identified patients are contacted and scheduled to meet with both the clinical pharmacist and care manager prior to a visit with their primary care physician. The pharmacist and care manager begin the visit by documenting barriers to improved health, updating the medication list in the electronic medical record, and placing lab-draw orders. This allows the physician to obtain a complete and accurate picture of the patient prior to the visit. Patients are then contacted at two, four, and 10 weeks after the initial visit for a follow-up visit or a telephone consultation with the clinical pharmacist or care manager. Pharmacist interventions range from medication and dietary counseling to medication changes and insulin titration. Dr. Selinger tracks the HbA1cs of these patients over time to determine the benefit from such interventions.  

Since the start of this program, the clinical pharmacist has set up specific clinic hours to handle the volume of referrals for her services from other providers in the clinic. For referred patients, she offers:

• Chronic disease management and education
• Medication reconciliation
• Medication therapy management
• Insulin education and management
• Dose titration

She is currently providing these clinical services and performing data collection in addition to her main duties of managing the clinic’s in-house retail pharmacy and providing all of the medications for each of the participants at the nearby Program of All-inclusive Care for the Elderly (PACE) Senior Care Center. Preliminary data from the first year of follow-up shows that about 40 percent of the cohort has reduced their HbA1c to below 9 percent. Since the project’s inception, a pharmacy intern has been hired to help with patient management and data collection. Through the efforts of Dr. Selinger over the past year, many patients have seen vast improvement in their diabetes control. The use of a clinical pharmacist can prove invaluable in patient care, in this instance improving HbA1c, a value that is directly related to patient outcomes and quality of life.

For more information on the efforts at Charles Drew, please contact Rachel Selinger, PharmD, at selinger@piedmonthealth.org. For more information on CCME’s Adverse Drug Events Program, contact in North Carolina, Jeana Partington, BSN, RN, CPHQ, CCME care improvement specialist, at 800-682-2650, ext. 5660, or at jpartington@ncqio.sdps.org. In South Carolina, contact Lynn Martinez-Page, BSN, RN, CCME care improvement specialist, at 800-922-3089, ext. 7557, or at lpage@scqio.sdps.org.

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