Pharmacists are integral members of healthcare teams in community health centers and hospital outpatient departments. They are often the first line of defense for preventing hospital readmissions and improving medication adherence. In 2017, Adirondack Medical Center began a new clinical service, a pharmacist-led collaborative drug therapy management program to expand into the ambulatory care area.
The collaborative drug therapy management extension for pharmacists’ licensure in New York state has allowed for clinical pharmacy services to be conducted in accordance with a written agreement from a voluntarily participating physician. Adirondack Medical Center’s program focuses on anticoagulation therapy and chronic care management. The physicians and pharmacists work closely together to achieve better results from patients’ drug therapies, improving their overall health. The hospital noted the importance of having a business plan to guide processes in a new service; however, flexibility is also essential as operational models change unexpectedly.
For the anticoagulation management service, the time in therapeutic international normalized ratio range increased by 18% in the 12 months post-initiation, compared to 12 months baseline data prior to the service. For the chronic care management service, the patients with diabetes seen by an ambulatory care pharmacist were found to have a 1.7% reduction in HbA1c with a baseline HbA1c greater than 9%. These are patients at risk for hyperglycemia, diabetic ketoacidosis and microvascular and macrovascular complications.
Indirect clinical and financial benefits include preventing hemorrhagic stroke, severe bleeding, thromboembolism, ischemic stroke, diabetes ketoacidosis and other complications related to diabetes as well as increased physician referrals and/or volume due to increased interaction with patients and pharmacists.