Model program for pharmacists as public health partners, and for the Department of Public Health to review the Center for Disease Control program guide for Partnering with Pharmacists in the Prevention and Control of Chronic Diseases to decide which model will work best for the a program in the Commonwealth. A pilot project in a specific region or with a specific large employer may be an option to consider. Be sure to build in a rigorous evaluation for the project at the beginning of the planning stage.

In the United States, health care extenders such as pharmacists, community health workers (CHWs), and patient navigators help us meet our national health goals by conducting activities and interventions that promote health and prevent diseases and disability. Health care extenders work closely with patients and providers to control chronic illness through education and counseling, communication with providers, and, in some cases, medication titration. Funded programs can play a role in reducing high blood pressure and high cholesterol by supporting high-level policy and systems changes that promote collaborative medication therapy management initiatives, train¬ing or certification of health care extenders to reach disparate populations, or the use of health care extenders in multidisciplinary clinical teams.

Health Care Systems Change Interventions

• Support policy development for pharmacist-led comprehensive medication therapy management

• Promote systems changes in health care settings that utilize health care extenders for care improvement

New ways to expand team-based health care are needed to protect the health of people of the Commonwealth. Many chronic diseases, which are increasing with the aging population, are preventable or manageable. The role of the pharmacist has expanded beyond just dispensing medications and is evolving into active participation in chronic disease management as a part of team-based care. Programs addressing chronic diseases in state health departments and communities can build team relationships through public and private partnerships.

As defined by the American Pharmacists Association, medication therapy management (MTM) is a term used to describe a broad range of health care services provided by pharmacists, the medication experts on the health care team.

In The Patient-Centered Medical Home: Integrating Comprehensive Medication Management to Optimize Patient Outcomes, the Patient-Centered Primary Care Collaborative defines comprehensive medication management as the standard of care that ensures each patient’s medications—whether they are prescription, nonprescription, alternative, traditional, vitamins, or nutritional supplements—are individually assessed to determine that each medication is appropriate for the patient, effective for the medical condition, safe given the comorbidities and other medications being taken, and able to be taken by the patient as intended. Within this system, each medication is assessed for the medical condition or indication for which it is taken. To produce clinically useful data, the indication must be electronically linked with the product, dose, duration, manner in which the medication is taken, therapy goals, clinical parameters that determine progress toward these goals, and actual outcomes. The clinical status of the patient must be determined for each drug and each condition (e.g., current blood pressure level and cholesterol levels for patients with high blood pressure and high cholesterol). Without knowledge of the current clinical status of a patient, the indication, appropriateness, and effectiveness of most medications cannot be determined.

Comprehensive medication management includes an individualized care plan that achieves the intended goals of therapy with appropriate follow-up to help the pharmacist determine actual patient outcomes. The pharmacist evaluates the outcome parameters against the patient’s individualized therapy goals and re-evaluates the patient to identify any new medication-related problems that might interfere with the safe and effective use of medications in the patient’s care plan. These follow-up evaluations occur in a time frame that is clinically appropriate for the specific patient as well as his or her medical conditions and drug therapy plan. Evaluation time frames vary with each patient and are triggered when major transitions—such as hospitalization—occur or at the request of the patient’s providers/prescribers.

Team-Based Care

According to the proposed definition from a working group of the Institute of Medicine, team-based health care is the provision of health services to individuals, families, and/or their communities by at least two health providers who work collaboratively with patients and their caregivers—to the extent preferred by each patient—to accomplish shared goals within and across settings.

Role of the Pharmacist in Team-Based Care

The role of pharmacists in providing patient care services is compatible and synergistic with the patient-centered medical home model and other innovative models of team-based care. Pharmacists extend the health care team to the local community, providing patients with the resources and care they need. In addition, pharmacists are some of the most accessible health care professionals and have a broader knowledge

A PROGRAM GUIDE FOR PUBLIC HEALTH Partnering with Pharmacists in the Prevention and Control of Chronic Diseases pharmacists know the medicines (prescription and over-the-counter) more than any other member of the health care team. Research shows real value in pharmacists’ management of diabetes and heart disease. For the millions of Americans with uncontrolled diabetes, the risk for heart disease, stroke, kidney failure, blindness, and amputation are significant. Engaging pharmacists as members of the health care system can significantly improve treatment of diabetes, better control high blood pressure, improve management of cholesterol, and reduce overall health care costs. nated, high-quality, and patient-centered care.

Partner with an organization or group that understands this area well. First, look within our state health department to determine if another program is conducting a similar project. It might be more appropriate to add a focus area to an existing project rather than develop a new one. An ideal partner in any pharmacist-based intervention program should be a program or organization that already has something similar.