Some recent studies, including one by the National Institute for Health Care Management Foundation, suggest that just five percent of patients account for up to 50 percent of all health care costs.
The NIHCM Foundation study identifies patients with multiple chronic diseases such as hypertension, high cholesterol and diabetes, as being at the highest risk for using a disproportionate amount of health care resources.
A collaborative effort spearheaded by Cherry Street Health Services Inc. of Grand Rapids and Pharmacy faculty and students from Ferris State University is improving the health of patients with multiple chronic conditions, and in the process helping ease the pressure on the health care system nationwide. This effort is taking place with support from the Patient Safety and Clinical Pharmacy Services Collaborative, a program of the Health Resources and Services Administration.
As the PSPC’s website explained, the program “uses a fast-paced iterative improvement method designed to support teams in testing and spreading leading practices found to significantly improve health outcomes and patient safety through the integration of clinical pharmacy services.” In other words, get pharmacists involved in helping to decide what medications the patient should be taking and tailor drug regimens that patients are more likely to actually maintain.
Fred Schmidt, director of Pharmacy at Cherry Street Health Services, recalled a recent encounter that illustrates the kind of impact a more integrated approach to health care management could have. He describes a patient whose life improved dramatically after Ferris Pharmacy professor John Jameson began consulting with her physician on her medications. “She said that she had a whole bag of medications, and doctors kept adding medications. She said she had to get a bigger bag,” Schmidt recalled. “But after her pharmacist and primary doctor began making decisions on what she should be taking, she said that now she was only taking a few medications, was in control of her blood pressure and felt good.”
This is just the kind of outcome the PSPC hopes to encourage.
“The reason we’ve had a lot of the success is, number one, when I see patients, I have the time to listen and understand situations in their lives, what meds they’re taking, what they’re not taking and why they’re not taking them so that I have a complete picture,” explained Jameson.
He said when a patient comes for an appointment, he often sees them with current Ferris student resident Susan DeVuyst-Miller, and will evaluate a patient’s drug regimen by asking questions about what medications the patient is taking, if the patient understands why he or she is taking them and what roadblocks are preventing them from following the medication schedule. Obstacles to compliance can include anything from unreported side effects to financial challenges.
“We find out what they’re taking, what they’re not taking, and why. Usually when I see a patient, it’s because things aren’t working,” Jameson said.
Dr. Leslie Pelkey, the primary physician on the PSPC Team, agrees that she has seen patient improvement — in part by patients becoming more invested in their health outcomes.
“Working as a team in collaboration with Ferris State University has reinvigorated our approach to treating hypertension,” she said. “We have been able to optimize treatment regimens for patients while eliminating side effects. This has improved compliance, and the patients have been excited to be part of the program. We have also seen patients take ownership in monitoring blood pressure at home.” Other positive outcomes have included patients losing weight, quitting smoking and making other healthy lifestyle changes.
PSPC has shown such promise that the Centers for Medicare and Medicaid Services want to expand the program so there are similar collaborative efforts in each state. Currently, Cherry Street Health Services has the only such model up and running in Michigan. And even though the effort has only been fully operational since December 2010, HRSA was impressed enough by the Cherry Street-Ferris State team to ask Schmidt and Mike Bouthillier, Ferris’ interim assistant Pharmacy dean, to take part in a national webcast to other health professionals about the success of their integrated approach.
“Nationally, there are learning sessions where different clinics present some of their results in what are called ‘Patient of Focus groups,’” explained Bouthillier. “Ours was trying to control peoples’ hypertension. We managed to get about two-thirds of patients who had uncontrolled blood pressures within goal and made significant gains on the others.” Bouthillier said that those are the kind of outcomes that HRSA hopes to achieve with expansion of the PSPC program.
For DeVuyst-Miller and others, the opportunity to perform a residency in such a collaborative setting establishes a new paradigm for the next generation of health care professionals. “In coming to this clinic with Dr. Jameson, I’ve seen what a pharmacist and a physician working together can do,” she said.
Interim Pharmacy Dean Steve Durst noted that it was a Ferris student, Sunao Alashi Slayton (P’10) who provided the impetus for the University to become involved. “It was her passion to get this set up as one of the demonstration clinics. She made it happen.
It was her seeing that this is what a pharmacist should be doing,” said Durst.
Slayton became interested in this type of ambulatory care as a result of her fourth-year experience in the Pharmacy program at Ferris.
“In my year four rotation, I realized there is a lot of work pharmacists can do to bridge the gap and advocate for patients,” she explained. “I wanted to create an avenue for Pharmacy students to be involved in that kind of care.” Slayton now has a successful career as a pharmacist and coordinator of the oncology pharmacy at Stamford Hospital’s Bennett Cancer Center in Stamford, Conn., where she is currently helping develop an oral chemotherapy dispensary for ambulatory patients.
Cherry Street Health Services just opened a new facility, the Heart of The City, which will help consolidate health care offerings and create new opportunities for collaboration between physicians, pharmacists and other health caregivers as part of a team through the PSPC program.
With its own new space on Grand Rapids’ “Medical Mile,” Ferris’ College of Pharmacy is poised to continue helping provide care to some of Grand Rapids’ most at-risk patients while educating pharmacists to work closely with physicians as prescription drugs become ever more powerful and complex.