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Week 5: Advocacy by Kelley Ratermann

If I could choose one word to describe my fifth week at AACP, it would be advocacy. I had the opportunity to attend a policy-related meeting with Will Lang, the Vice President of Policy and Advocacy at AACP, and his assistant Whitney Zatskin. As we traveled from Alexandria to Mercy Health Clinic Gaithersburg, Maryland, they caught me up to speed on the importance of this meeting.  At the request of staff from the Office of Management and Budget (OMB), Will graciously chose Mercy Health Clinic (MHC) to display the role of the pharmacist amongst a collaborative healthcare team. The main goal was to provide OMB staff with a great example of the services provided by pharmacists through medication therapy management (MTM) and demonstrate how collaboration among healthcare professionals provides a much higher level of care.

Many strategic individuals were present for this meeting with OMB staff, all of who shared one common theme of support for pharmacists and their expanded role in healthcare. Upon glancing around the room, I took note of those in attendance:  the Chairman of the Board of MHC, the Chief Medical Officer of MHC, faculty from University of Maryland COP with dual appointments as staff pharmacists at MHC, University of Maryland student pharmacists, pharmacy residents from Suburban Hospital, an independent pharmacist, the Chair of Pharmacy Practice and Science at the University of Maryland College of Pharmacy, and various other staff members from MHC including the CEO. The room was packed and I was initially concerned that with so many different voices and opinions being presented, there would not be a unified message…but my concerns were superfluous. Over the course of the next 4 hours I would continually be impressed by the poise, organization, and passion displayed by those who presented information. A necessary level of detail was required to accurately present the data that MHC has compiled over the course of its existence; along with the detail came definitions and explanations to ensure everyone fully comprehended the significant achievements that have been made with MHC’s patient care model.

The presentation initiated with a discussion centered on defining MTM and its beneficiaries:  the students and residents being trained, the pharmacists and faculty who teach and work to their full potential, and the ultimate winner is the patient that receives the service and lives a healthier, better quality of life. Next, the discussion moved more towards understanding that the practice of MTM is a difficult concept for many to grasp because it is an intangible product—it is not something that can be seen or touched, like a pill bottle, but rather must simply be experienced by the patient. Other benefits cited included additional free time for the physician to devote to more expertise to acute cases and increased autonomy for pharmacists and other healthcare professionals that meet with patients who qualify for MTM to monitor more chronic disease states. The pharmacists emphasized that the best way to promote this value-added service is to share experiences about how beneficial MTM is to improving overall health, which coincidentally was the exact purpose of this advocacy meeting!

Next on the docket were the cold, hard facts. MHC staff painted the gruesome picture that represents the average patient within the underserved population that they serve. On average (during the first year they collected data), each patient took 8 different medications and had been diagnosed with 4.5 chronic conditions.  The majority of patients had type II diabetes, with average A1c values around 8.8%. Unfortunately, many patients do not understand the indications for their medications or how to take them correctly and therefore they do not receive benefits from these chemicals because of low adherence. Collecting this information and understanding how to combat it are two completely separate battles, as was clearly stated by one of the pharmacists in the room, “drugs don’t work in patients who don’t take them.”

The major take-home point in all of this was that the professionals at MHC have found a way to make a meaningful difference—despite the poor prognosis for many of their patients upon presentation—because of their coordination of activities. For example, pharmacists participating in MTM services implemented a system to refer patients who meet criteria to nutrition, dental, endocrine, and mental health services (just to name a few). Each interaction with a healthcare provider is recorded and centrally stored for ease of access and maximal communication. The emphasis of their practice model relies on collaboration and care coordination in order to maintain high levels of success for improving patient outcomes. The data speaks for itself and the professionals who volunteer in this environment agree that it works; this is evidenced by their numerous awards and continued funding, including a Legacy Grant from the CDC and article highlighting their model in the July 2012 issue of Pharmacy Today.

The aspect of this meeting that I found most impressive was the level of attention that the OMB staffers maintained throughout the 4 hours of presentations they attended. Many took notes and asked pointed questions, the most interesting of which I thought was a concern of whether or not a patient that meets with the pharmacist more often for MTM sessions correlates to less visits with the primary care physician, hence lower healthcare costs. The resounding answer was “yes,” meeting with a pharmacist to help a patient better understand their medication ultimately leads to better adherence, increased outcomes, and decreased long-term costs. MHC staff pointed out that, “an educated consumer is the best client.” This philosophy was exemplified beautifully as the pharmacist brought in a diabetic patient and his wife for a real-time MTM session discussing diet, blood glucose monitoring, changes in therapy due to lab values, and answering any questions that the patient had. This comprehensive review served the patient and allowed for an audio and visual learning experience for the OMB staff to fully understand what these services entail during a typical MTM session.

Finally, the Chief Medical Officer spoke about the future of American healthcare and how this ties in with her philosophies. She noted that it is an exciting time because more American citizens will be eligible for healthcare with the passing of new legislation, but that this is simultaneously scary because there are not increased numbers of physicians that are graduating at the same pace…therefore pharmacists will be needed to help fill this gap. She pulled from her own experiences in her personal practice and from those at MHC and said the return on investment for employing a pharmacist as a member of the healthcare team is at a minimum 2.5-to-1. This was fantastic to hear because it means the value of a pharmacist is apparent to this physician and now she will serve as a champion for our profession. As a result, the primary goal of highlighting the pharmacist’s role in a positive light was achieved by professionals within and outside of our profession. I appreciate the opportunity to have attended such an enlightening meeting, and I was reenergized to continue my own advocacy efforts for the betterment of our patients and our profession.

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