Clinician Discusses How To Support A Team-Based Model Between Pharmacists, Physicians

Pharmacy Times interviewed Michael Barr, MD, MBA, MACP, FRCP, on the importance of collaboration between pharmacists and physicians in the clinical care setting, highlighting the need for a team-based model.

Question: How do physicians and pharmacists work together to provide comprehensive medication managment for patients?

Michael Barr: Of course, it starts with the person needing the care- the patient and her situation. And it also includes understanding that well organized team-based care is the best way to approach patient needs, especially those who have challenging situations or complex clinical conditions. So the clinical pharmacist and physicians and clinicians. Now I use those words specifically. So physicians mean doctors, MDs and DMs. But I like to use the word "clinicians" when I refer to physicians, nurse practitioners and physician assistants, working with clinical pharmacists- for the purposes of addressing the needs of individuals. And in this context, we talk about comprehensive medication management as a standard way of assessing the needs of the person with respect to his or her medications, and in the context in which they're taking those medications. So there are a lot of different ways this can happen in terms of how it works, and so we can talk about those if you'd like to in terms of mechanics.

Question: How can physician and pharmacist collaboration impact patient outcomes?

Michael Barr: Well, I mean, let's talk about specific patients- people generally with chronic conditions or difficult to manage conditions or complex situations. The way a physician, or clinicians, and clinical pharmacists work is first acknowledging the respective responsibilities and knowledge and skills that they bring to the table as part of an interprofessional team. And in that context, knowing what a person needs (and collectively contributing to the information to support the care of that person) is what this dynamic kind of team-based care is meant to accomplish. A clinical pharmacist can supplement the care that the physician or clinicians provide by really amplifying the understanding. By that I mean talking to people about the context of the unique situations; the challenges with taking their medications, the barriers to management of their chronic conditions, the situations in which they live. It's really hard for physicians, in the context of a brief encounter, to get all that additional context and understand the living situation or the life situation of the people that trust them to take care of them. That's where clinical pharmacy is working together with a physician or clinician, and the rest of the team operates best. So how can they work it can be through in person care could be through virtual telephonic or video calls, even via (once you get to know the person) asynchronous secure messaging- their apps or emails. And we have examples of a lot of those types of engagements on the Get the Medications Right Learning Center website, or web pages.

Question: Can you provide any real world examples that demonstrate the imact of pharmacists being a part of patient care teams?

Michael Barr: Absolutely, and again, I'd refer readers or listeners to the website. But I can cite a few for you to have as part of this conversation. Texas Department, Texas primary care clinics, the reduction and medication therapy problem, saved over $1,100 per patient. And most of the recommendations, through this sort of collaborative, comprehensive  medication management were related to safety or adverse drug reactions or recommendations to avoid those. There was a Medicaid plan that the telephonic outreach, by clinical pharmacist to patients, and then fit recommendations back to clinicians that resulted in significant total cost savings of over $500 a month in total, and $190 plus per month in medication costs. And then a large practice (over 10 years) dealt with 1000s of patients and found that through their interactions with people, they resolve many medication therapy-related problems and the categorizations were that 27% needed additional drug therapy, 26% had sub-therapeutic doses of their existing medication regimens, and 13% of those issues related to unnecessary drug therapy and inappropriately high dosages. And only a subset was related to medication adherence, which often gets a lot of airtime and airplay, but a lot of it is about adjusting existing medications and stopping medications as well as of course helping people adhere to the recommendations in that drug medication regimen.

Question: What could be done to improve communicaiton and collaboration between physicians and pharmacists to improve comprehensive medication management for patients?

Michael Barr: First, I think we need to train better together. In other words, moving upstream and healthcare professionals learning how to work together and team-based interprofessional environment is really important.  We need to start supporting that in ways that have not been the case before. That's not just with clinical pharmacists and physicians, but nurses, social workers, behavioral health therapists, and so on. So we take that as sort of a first step. The next step is to make sure a lot of the technology we have in place facilitates the sharing of information, the collaboration, and documentation on behalf of the patients, so that we all know as team members, what's going on with a person, what changes are being made, what improvements can be made, and how the person is doing in response to treatment and regimens that we have in place. EHR usability will be a short way of saying what I just said with regard to talk documentation and technology, but that's only part of it- how we talk to each other, what forms of communication and documentation we do, and so on. So I think there are a lot of opportunities to enhance what we're describing in terms of the collaboration. It's not just the technology. It's about the culture, it's about the payment models and so on to support this team-based model.