PRISM Primary Care

Approximately 3 billion prescriptions are written in physician office visits, and 75% of office visits involve drug therapy.  Patients receiving medications for multiple chronic conditions are at risk for medication-related misadventures.  The IOM estimated that 1.5 million people are harmed by medications annually, 25% of ambulatory care patients experience adverse drug events (ADEs), $3.5 billion is spent on extra medical costs of ADEs annually, and at least 40% of costs of ambulatory (non-hospital settings) ADEs are estimated to be preventable. Approximately 700,000 emergency department visits and 120,000 hospitalizations are due to ADEs annually

Pharmacists practicing with primary care teams concentrate on 5 core elements of patient-centered medication use and safety: (1) comprehensive review of current prescribed and self-care medications and dietary supplements for usage and patterns; (2) systematic assessment of each medication for appropriateness, effectiveness, safety, and adherence to achieve optimal therapy goals; (3) monitoring plan for  the therapeutic effectiveness and potential toxicity of all prescribed medications, including laboratory monitoring; (4) development of a personal medication care plan with self-management goals and medication optimization recommendations; and (5) documentation and communication of the care plan to the patient and all health care providers. The personalized medication care plan contains the pharmacist’s recommendations to avoid medication errors and resolve inappropriate medication selection, omissions, duplications, sub-therapeutic or excessive dosages, drug interactions, adverse events, adherence problems, cultural competency and health literacy challenges, and costly regimens. The pharmacist’s medication care plan recommendations can be shared with the primary care provider before or during a patient’s primary care visit. Such clinical services can occur in various locations, such as primary care offices, outpatient clinics, home visits, work-site health programs, senior centers, and community pharmacists’ practices.  Although initial patient visits should be face-to-face meetings, pharmacists may use a combination of individual visits, group sessions, phone calls, telehealth, and electronic consultations for follow-up visits. The appropriate pharmacist-patient visit, whether in person or via one of the other options, depends on the complexity of the patient’s medication regimen, therapeutic needs, medication adherence trends, the number and type of identified medication-related problems, and the patient’s progress toward meeting medication self-management goals.

Publications in this area include:

Smith M.  Primary Care Teams and Pharmacist Staffing Ratios: Is There a Magic Number? Ann Pharmacother. 2017 Oct 1. doi: 10.1177/1060028017735119.Smith_ PC Pharm Staffing Ratio_AnnPcoTx 2017 (002)

Smith M.  Implementing Primary Care Pharmacist Services: Go Upstream in the World of Value-based Payment Models. RSAP

Isetts BJ, Buffington DE, Carter BL, Smith M, Polgreen LA, James PA. Evaluation of Pharmacists’ Work in a Physician-Pharmacist Collaborative Model for the Management of Hypertension. Pharmacotherapy. 2016 Apr;36(4):374-84.

Smith M, Pezzullo L, Kuhle J, Eisenberg W.  Medication Management: Measuring What Matters.  Am J Pharm Benefits. 2015; 7(1):38-42.

Smith M, Cannon-Breland M, Spiggle S. Consumer, physician, and payer perspectives on primary care medication management services with a shared resource pharmacists network. Research in Social and Administrative Pharmacy.2014; 10(3):539-553.

Smith M and Wick J. Galvanizing Growth: Value-Based Medication Management Services in Medical Homes and ACOs.   Am J Pharm Benefits. 2014;6(1):e18-e23.

Smith M, Bates DW, Bodenheimer TS. Pharmacists Belong In Accountable Care Organizations And Integrated Care Teams.  Health Affairs. 2013; (11):1963-1970.

Smith M.  Pharmacists and the Primary Care Workforce.  Annals of Pharmacotherapy, 2012 Nov; 46(11):1568-71

Abrons J and Smith M.  Patient-centered medical homes: Primer for pharmacists.  J Am Pharm Assoc. 2011; 17(5):52-64.

Smith M, Giuliano MR, Starkowski MP. In Connecticut: Improving Patient Medication Management in Primary Care.   Health Affairs 30, no 4 (2011): 646-654.

Smith M, Bates DW, Bodenheimer T, Cleary PD. Why Pharmacists Belong in the Medical Home. Health Affairs 29, no. 5 (2010): 906-913.   [161 citations – Feb 2017]

Smith MA, Dang D, Lee J. E-Prescribing Clinical Implications with Diabetes Patients. J Diabetes Sci Technol 2009;3(5): 1215 – 1218.

Funded grant projects in this area include:

3D Team Care for Cognitively Vulnerable Older Adults. Sponsor: PCORI ($5Million); PI-Rick Fortinsky; Co-I: Marie Smith

Developing Strategies for Community-Based Medication Management Services in Value-based Health Plans.  Sponsor: Community Pharmacy Foundation ($26,266).  PI: Marie Smith

Consumer, Physician, and Payer Perspectives on Primary Care Medication Management Services with a Shared Resource Pharmacists Network. Sponsor: Community Pharmacy foundation ($55,000). PI: Marie Smith.

Medicaid Transformation Grant: Hospital-to-Home Care Transition: Medication Reconciliation and Targeted Medication Management Pilot Project.  Sponsor: CMS/CT Department of Social Services  -Medicaid Agency ($150,000).  PI: Marie Smith, Co-Is: Devra Dang, Tom Buckley.

Medicaid Transformation Grant:  Primary Care Medication Therapy ManagementSponsor: CMS/CT Department of Social Services – Medicaid Agency ($781,909).  PI: Marie Smith, Co-Is: Devra Dang, Tom Buckley.