Pharmaceutical care in an integrated health system

OBJECTIVES: An integrated health system in a large metropolitan area, to maximize its manpower and resources, developed a pharmacist-operated Health Management Center (HMC). The primary objectives of the HMC are to provide a continuum of patient care, decrease emergency department visits, decrease episodes of hospitalization, and increase patient satisfaction and quality of life. SETTING: The HMC based at a 300-bed community hospital of an integrated health system in a large metropolitan area. PRACTICE DESCRIPTION/INNOVATION: Chronic diseases, including coagulation disorders, asthma, diabetes, hypertension, congestive heart failure, and dyslipidemia, will be managed by the primary care pharmacist at the HMC. The HMC pharmacist uses a team approach to promote good health by cooperating with patients, the physician clinic director, and other professionals in designing, implementing, and monitoring therapeutic plans that produce specific therapeutic outcomes. The pharmacist evaluates patients using physical assessment skills; performs point-of-care laboratory tests; obtains medication history, including information on compliance, response to drug therapy, and adverse reactions; adjusts and orders medications; and schedules follow-up appointments. INTERVENTIONS: The anticoagulation service was the first program to be established. The pharmacist is authorized to perform point-of-care testing for prothrombin times, adjust doses of anticoagulants, order vitamin K, and schedule return visits per established guidelines. MAIN OUTCOME MEASURES: Emergency department visits, episodes of hospitalization, patient satisfaction, and quality of life. RESULTS: The results for 39 patients 6 months before their enrollment in the HMC's anticoagulation service and for the first 6 months following their enrollment, after adjusting for a 1-month-washout period, showed a decrease in hospitalization rate by 57.9% (p = .078) and total hospital days by 71.1% (p = .108). No change was observed in use of emergency department services. CONCLUSION: The role of the pharmacist at the HMC is a reflection of changes in the health care system that are leading to greater pharmacist involvement in direct patient care. The pharmacist-operated HMC can serve as a model for other hospitals in this and other integrated health systems.