Special Issue "Embedded Pharmacists in Primary Care"

A special issue of Pharmacy (ISSN 2226-4787).

Deadline for manuscript submissions: closed (31 October 2020).

Printed Edition Available!
A printed edition of this Special Issue is available here.

Special Issue Editors

Prof. Dr. George E. MacKinnon III
E-Mail Website
Guest Editor
School of Pharmacy, Department of Family & Community Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA
Interests: demonstrating the value of pharmacists; interprofessional education and practice; population health; pharmacoeconomics
Special Issues and Collections in MDPI journals
Dr. Nathan Lamberton
E-Mail Website
Guest Editor
School of Pharmacy, Department of Family & Community Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA
Interests: primary care; chronic disease management; interprofessional collaboration; vaccination and medication access

Special Issue Information

Dear Colleagues,

Given the projected shortage of primary care providers (PCPs), the explosion of high cost specialty pharmaceuticals, future use of pharmacogenomics in precision medicine, and value-based reimbursements, the addition of a pharmacist to most physician practices will be financially prudent, if not essential.

The work environments and expectations for primary care physicians’ daily activities include spending a significant amount of time related to chronic care management, including managing complex medication regimens. The Association of American Medical Colleges (AAMC) 2017 Report projected shortfalls in primary care range between 7300 and 43,100 physicians by 2030 in the United States. Ergo, a future should be envisioned where pharmacists are embedded in primary care settings, as primary care pharmacist practitioners (e.g., PCPPs). The benefits of such providers include enhanced medication adherence, fewer adverse drug-related events, reduced inappropriate healthcare utilization (e.g., emergency room visits, hospitalizations, office visits), improved clinical outcomes, total reduced cost of care (assessing pharmaceuticals as part of this), greater patient satisfaction, and higher CMS Star Ratings.

Appropriately leveraging the role of the pharmacist in primary care settings to achieve better health outcomes in all patients and achieve not only the Triple but Quadruple Aim is a value proposition worthy of exploration by all members of the healthcare team.

We look forward to manuscript submissions that embody this spirit and desire to articulate and demonstrate the value of embedding pharmacists in primary care practice settings.

Founding Dean and Prof. George E. MacKinnon III, PhD, MS, RPh
Assist. Prof. Nathan Lamberton, PharmD, BCPS
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Pharmacy is an international peer-reviewed open access quarterly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Pharmacist–physician collaboration
  • Comprehensive medication management
  • Chronic care management
  • Team-based primary care
  • Primary care workforce
  • Improving care transitions

Published Papers (9 papers)

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Editorial

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Editorial
Concept for Embedded Primary Care Pharmacist Practitioners (PCPPs): A Disruptive Value-Proposition
Pharmacy 2020, 8(4), 195; https://doi.org/10.3390/pharmacy8040195 - 23 Oct 2020
Viewed by 567
Abstract
The work environments and expectations for the daily activities of primary care physicians are daunting and often include spending a significant amount of time related to chronic care management with complex medication regimens, medication reconciliation, and the documentation within the electronic medical record [...] Read more.
The work environments and expectations for the daily activities of primary care physicians are daunting and often include spending a significant amount of time related to chronic care management with complex medication regimens, medication reconciliation, and the documentation within the electronic medical record (EMR) of these medication related issues [...] Full article
(This article belongs to the Special Issue Embedded Pharmacists in Primary Care)

Research

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Article
How a State Measures Up: Ambulatory Care Pharmacists’ Perception of Practice Management Systems for Comprehensive Medication Management in Utah
Pharmacy 2020, 8(3), 136; https://doi.org/10.3390/pharmacy8030136 - 01 Aug 2020
Viewed by 900
Abstract
Comprehensive medication management (CMM) is a patient-centered standard of care that ensures a patient’s medications are optimized. The CMM Practice Management Assessment Tool (PMAT) is a tool to assess areas of CMM practice management. The purpose of this project was to assess the [...] Read more.
Comprehensive medication management (CMM) is a patient-centered standard of care that ensures a patient’s medications are optimized. The CMM Practice Management Assessment Tool (PMAT) is a tool to assess areas of CMM practice management. The purpose of this project was to assess the state of CMM practice management based on clinical pharmacist perception for two health systems in the state of Utah, and to identify areas of excellence and/or improvement utilizing a novel method for PMAT analysis. The PMAT was distributed to all primary care-focused ambulatory care pharmacists employed by University of Utah Health (U of U Health) and Intermountain Healthcare (Intermountain). Ordinal responses were assigned to three possible categories of CMM support (High, Indifferent, and Low). Ten surveys were completed from U of U Health, and nine were completed from Intermountain. Thirty-two of the 86 survey questions resulted in a high level of support, and 25 questions resulted in a low level of support from the majority of respondents. Statistically significant differences between the institutions were found for 18 questions. The utilization of the PMAT within two Utah health systems highlighted areas of excellence and improvement and demonstrates a unique method for analysis of PMAT results. Full article
(This article belongs to the Special Issue Embedded Pharmacists in Primary Care)
Article
Expansion and Evaluation of Pharmacist Services in Primary Care
Pharmacy 2020, 8(3), 124; https://doi.org/10.3390/pharmacy8030124 - 22 Jul 2020
Cited by 1 | Viewed by 717
Abstract
Challenges with primary care access and overextended providers present opportunities for pharmacists as patient care extenders for chronic disease management. The primary objective was to align primary care pharmacist services with organizational priorities and improve patient clinical outcomes. The secondary objective was to [...] Read more.
Challenges with primary care access and overextended providers present opportunities for pharmacists as patient care extenders for chronic disease management. The primary objective was to align primary care pharmacist services with organizational priorities and improve patient clinical outcomes. The secondary objective was to develop a technological strategy for service evaluation. An interdisciplinary workgroup developed primary care pharmacist services focused on improving performance measures and supporting the care team in alignment with ongoing population health initiatives. Pharmacist collaborative practice agreements (CPAs) were developed and implemented. An electronic dashboard was developed to capture service outcome measures. Blood pressure control to <140/90 mmHg was achieved in 74.15% of patients who engaged with primary care pharmacists versus 41.53% of eligible patients electing to follow usual care pathways. Appropriate statin use was higher in patients engaged with primary care pharmacists than in eligible patients electing to follow usual care pathways both for diabetes and ischemic vascular disease (12.4% and 2.2% higher, respectively). Seventeen of 54 possible process and outcome measures were identified and incorporated into an electronic dashboard. Primary care pharmacist services improve hypertension control and statin use. Service outcomes can be measured with discrete data from the electronic health record (EHR), and should align with organizational priorities. Full article
(This article belongs to the Special Issue Embedded Pharmacists in Primary Care)
Article
Practice Transformation Driven through Academic Partnerships
Pharmacy 2020, 8(3), 120; https://doi.org/10.3390/pharmacy8030120 - 14 Jul 2020
Viewed by 702
Abstract
Evidence-based interventions have been shown to improve the quality of patient care, reduce costs, and improve overall health outcomes; however, adopting new published research and knowledge into practice has historically been slow, and requires an active, systematic approach to engage clinicians and healthcare [...] Read more.
Evidence-based interventions have been shown to improve the quality of patient care, reduce costs, and improve overall health outcomes; however, adopting new published research and knowledge into practice has historically been slow, and requires an active, systematic approach to engage clinicians and healthcare administrators in the required change. Pharmacists have been identified as important agents of change and can enhance care delivery in primary care settings through evidence-based interventions. Utilizing the Consolidated Framework for Implementation Research (CFIR) we identify, assess, and share barriers and facilitators to program development, as well as growth and expansion efforts across five discrete, university-subsidized, embedded-pharmacy practices in primary care. We identified two overarching modifiable factors that influence current and future practice delivery and highlight the role of academia as an incubator for practice change and implementation: Data collection and information sharing. Conceptual frameworks such as CFIR help establish a common vernacular that can be used to facilitate systematic practice site implementation and dissemination of information required to support practice transformation. Full article
(This article belongs to the Special Issue Embedded Pharmacists in Primary Care)
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Article
Diabetes-Related Patient Outcomes through Comprehensive Medication Management Delivered by Clinical Pharmacists in a Rural Family Medicine Clinic
Pharmacy 2020, 8(3), 115; https://doi.org/10.3390/pharmacy8030115 - 09 Jul 2020
Cited by 1 | Viewed by 770
Abstract
Two clinical pharmacy faculty members from a college of pharmacy provide comprehensive medication management in a rural family medicine clinic. The data was assessed for patients with diabetes managed by the pharmacists from 1 January 2017 through to 31 December 2019 to determine [...] Read more.
Two clinical pharmacy faculty members from a college of pharmacy provide comprehensive medication management in a rural family medicine clinic. The data was assessed for patients with diabetes managed by the pharmacists from 1 January 2017 through to 31 December 2019 to determine the service’s impact on patient outcomes. The primary outcome of this study is the change in the goal attainment rates of the three clinical goals of hemoglobin A1c, blood pressure, and appropriate statin therapy after pharmacist intervention. A total of 207 patients were included. At baseline, the patients had an average of 1.13 of the three goals met, improving to an average of 2.02 goals met after pharmacist intervention (p < 0.001). At baseline, 4.8% of the patients had met all three clinical goals, improving to 30.9% after pharmacist intervention (p < 0.001). There were significant improvements for the individual goal attainment rates of hemoglobin A1c (24.15% vs. 51.21%, p < 0.001), blood pressure (42.51% vs. 85.51%, p < 0.001), and appropriate statin therapy (45.89% vs. 65.70%, p < 0.001). This data adds to the evidence supporting the integration of clinical pharmacists into primary care clinics to improve patient outcomes related to diabetes. Full article
(This article belongs to the Special Issue Embedded Pharmacists in Primary Care)
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Review

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Review
The Evolving Role and Impact of Integrating Pharmacists into Primary Care Teams: Experience from Ontario, Canada
Pharmacy 2020, 8(4), 234; https://doi.org/10.3390/pharmacy8040234 - 07 Dec 2020
Cited by 3 | Viewed by 1130
Abstract
The movement to integrate pharmacists into primary care team-based settings is growing in countries such as Canada, the United States, the United Kingdom, and Australia. In the province of Ontario in Canada, almost 200 pharmacists have positions within interdisciplinary primary care team settings, [...] Read more.
The movement to integrate pharmacists into primary care team-based settings is growing in countries such as Canada, the United States, the United Kingdom, and Australia. In the province of Ontario in Canada, almost 200 pharmacists have positions within interdisciplinary primary care team settings, including Family Health Teams and Community Health Centers. This article provides a narrative review of the evolving roles of pharmacists working in primary care teams, with a focus on evidence from Ontario, as well as drawing from other jurisdictions around the world. Pharmacists within primary care teams are uniquely positioned to facilitate the expansion of the pharmacist’s scope of practice, through a collaborative care model that leverages, integrates, and transforms the medication expertise of pharmacists into a reliable asset and resource for physicians, as well as improves the health outcomes for patients and optimizes healthcare utilization. Full article
(This article belongs to the Special Issue Embedded Pharmacists in Primary Care)

Other

Case Report
Pilot Study: Evaluating the Impact of Pharmacist Patient-Specific Medication Recommendations for Diabetes Mellitus Therapy to Family Medicine Residents
Pharmacy 2020, 8(3), 158; https://doi.org/10.3390/pharmacy8030158 - 31 Aug 2020
Viewed by 743
Abstract
Pharmacists have demonstrated effectiveness in managing diabetes mellitus (DM) and lowering hemoglobin A1C (A1C) through direct patient management. Often patients with diabetes and elevated A1C may not be able to come into the clinic for separate appointments with a pharmacist or for diabetes [...] Read more.
Pharmacists have demonstrated effectiveness in managing diabetes mellitus (DM) and lowering hemoglobin A1C (A1C) through direct patient management. Often patients with diabetes and elevated A1C may not be able to come into the clinic for separate appointments with a pharmacist or for diabetes education classes. A novel way that pharmacists can assist in improving the control of patients’ diabetes and improve prescriber understanding and the use of medications for diabetes is by providing medication recommendations to medical residents prior to the patient’s appointment with the medical resident. The results of this pilot study indicate that the recommendations provided to family medicine residents and implemented at the patient’s office visit helped to lower A1C levels, although the population size was too small to show statistical significance. This pilot study’s results support performing a larger study to determine if the pharmacist’s recommendation not only improves patient care by lowering A1C levels but if it also helps improve medical resident’s understanding and use of medications for diabetes. Full article
(This article belongs to the Special Issue Embedded Pharmacists in Primary Care)
Case Report
From Pilot to Scale, the 5 Year Growth of a Primary Care Pharmacist Model
Pharmacy 2020, 8(3), 132; https://doi.org/10.3390/pharmacy8030132 - 30 Jul 2020
Viewed by 787
Abstract
This case report details the five year journey of implementing, growing and optimizing a primary care pharmacist model in the ambulatory clinic setting within a health system. There is published evidence supporting the numerous benefits of including pharmacists in the primary care medical [...] Read more.
This case report details the five year journey of implementing, growing and optimizing a primary care pharmacist model in the ambulatory clinic setting within a health system. There is published evidence supporting the numerous benefits of including pharmacists in the primary care medical team model. This case report provides information regarding evolution of practice, the pharmacists’ roles, justification and financial models for the pharmacist services, as well as lessons learned and determined conclusions. Full article
(This article belongs to the Special Issue Embedded Pharmacists in Primary Care)
Case Report
Trends in Clinical Pharmacist Integration in Family Medicine Residency Programs in North America
Pharmacy 2020, 8(3), 126; https://doi.org/10.3390/pharmacy8030126 - 24 Jul 2020
Viewed by 683
Abstract
(1) Objective: To determine the change in prevalence of clinical pharmacists as clinician educators within family medicine residency programs (FMRPs) in North America and to describe their clinical, educational and administrative scope over time. (2) Methods: A systematic review of the [...] Read more.
(1) Objective: To determine the change in prevalence of clinical pharmacists as clinician educators within family medicine residency programs (FMRPs) in North America and to describe their clinical, educational and administrative scope over time. (2) Methods: A systematic review of the literature was performed starting with an electronic search of PubMed and Embase for articles published between January 1980 and December 2019. Studies were included if they surveyed clinical pharmacists regarding their clinical, educational, or other roles in FMRPs in the United States or Canada. The primary outcome was the change in prevalence of clinical pharmacists in North America. Secondary outcomes included: demographic information of clinical pharmacists, change in the prevalence in Canada and United States, and descriptions of clinical services, educational roles, and other activities of clinical pharmacists within FMRPs. (3) Results: Of the 65 articles identified, six articles met the inclusion criteria. The prevalence of clinical pharmacists as clinician educators in FMRPs in North America has grown from 24% to 53% in the United States (U.S.) and from 14% to 47% in Canada over the study period. The clinical and educational roles are similar including: the direct patient care, clinical education, and interprofessional education and practice. (4) Conclusion: The prevalence of clinical pharmacists in FMRPs is growing across North America. Clinical pharmacists are highly educated and trained to support these clinician educator positions. While educational roles are consistent, clinical pharmacists’ patient care roles are unique to their clinical site and growing. Full article
(This article belongs to the Special Issue Embedded Pharmacists in Primary Care)
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