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University of Colorado Denver

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Patient Care

Pilot Project Expands Capability of Salud Clinics


 

A $500,000 grant by the Colorado Health Foundation has allowed the School to partner with Salud Family Health Centers to expand the role of clinical pharmacy into the comprehensive line up of health care services the clinics provide. This two-year grant enables two clinical pharmacy faculty members -- Drs. Emily Kosirog and Jeff Freund (both with PGY2 specialty training in ambulatory care) -- to join the provider team at Salud and focus on comprehensive medication management of chronic diseases such as hypertension, dyslipidemia and diabetes.

“The grant extends what we have been able to do and adds another layer of care to the services we provide,” says Tillman Farley, MD, executive vice president of medical services at the Salud Family Health Centers.

Salud, an example of a patient-centered medical home (PCMH), offers coordinated, comprehensive, high quality preventive and primary health care to its patients in nine centers in northeastern Colorado. Everything from dental to behavioral health to primary care, chronic disease management and prescriptions are all under one roof. “It’s really one stop shopping and extremely patient-focused,” says Assistant Professor and Director of Clinical Affairs Gina Moore, PharmD, MBA.

Pulling physicians, nurses, pharmacists, physician assistants, dentists, and social workers together under one roof helps deliver coordinated care and preventive services much more effectively.  These types of centers place emphasis on the coordination and comprehensiveness of care, the ability to manage patients with multiple health care needs, and the use of key quality improvement practices, including health information technology. The PCMH model also overcomes geographic, cultural, linguistic and other barriers through a team‐based approach to care with an orientation toward the whole person. 

“Much of patient centered care has to do with getting the patient to the right person at the right time for the right problem. Clinical pharmacists are highly knowledgeable about medication management, so they are often more appropriate to be seeing patients than the physician is. Moreover, using clinical pharmacists to deal with chronic disease management can free the physician up to be able to see more patients with difficult diagnostic and treatment dilemmas, which in turn increases the capacity of the entire team,” says Dr. Farley.

Even though millions of Americans receive care through this type of system, there is still resistance. But with the passage of the Affordable Care Act (ACA) and Medicaid expansion it’s believed that these types of centers are poised to play an essential role in the implementation of the new law. Farley says, “Many physicians are not used to this model of care and may be hesitant to turn their patients over to clinical pharmacists for follow up care. I think ultimately we will need to demonstrate how it improves patient care in order for physicians to accept it.”

Halfway into the two-year grant, the clinical pharmacists have developed collaborative drug therapy management protocols, customized electronic health records and served more than 1400 patients. According to Farley, “Patients have no problem with it. They see it as value added care. Physicians and midlevels need a little more coaxing. I am confident that we will see an improvement in our chronic disease outcomes based on this program.”