Theme 3: Patient Care

Theme 3 in Leading Change: Strategic Plan 2015–2020 is:

Patient care: reframing how the medication needs of patients are met

Goals

  1. Provide the evidence for safe medication use practices at UCSF Medical Center and beyond

  2. Translate data into more precise medication decisions for individual patients

  3. Influence policy that affects health science research and patient care

Changes to theme in 2017


Goal 1: Provide the evidence for safe medication use practices at UCSF Medical Center and beyond

3.1.1

Demonstrate the value of establishing relationships between pharmacists and the patients they serve … by creating models of care that allow for effective communications.

Driver: Lisa Kroon, PharmD

With: Department of Clinical Pharmacy faculty; Daniel Wandres, PharmD

Progress to 2017

Working with Valerie Clinard, PharmD, and UCSF Department of Pharmaceutical Services Clinical Supervisor Ashley Thompson, PharmD, we surveyed UCSF PharmD students in Advanced Pharmacy Practice Experiences and UCSF PharmD students in summer Introductory Pharmacy Practice Experiences and their preceptors on the value-add of the pharmacy student to the clinical service and/or project. Results to date are very encouraging, with our students showing a real value-add to UCSF Medical Center.

Based on the data framework Marilyn Stebbins, PharmD, created for a 48-hour discharge phone program, in our two new ambulatory care services (Hill Physicians-Healthnet B&G ACO described in 3.1.2 and Cardiology), we are tracking pharmacist interventions using Cypher Health with the goal of showing impact on economic and clinical outcomes.

Based on the success of a pilot study with the UCSF Division of Cardiology and a start-up company called Vital Labs during which Department of Clinical Pharmacy pharmacists Lisa Kroon, PharmD, Marilyn Stebbins, PharmD, and Valerie Clinard, PharmD, provided telehealth management of hypertension, the Division of Cardiology hired a Department of Clinical Pharmacy pharmacist, Rose Pavlakos, PharmD, to provide comprehensive medication management services in cardiology.

3.1.2

Ensure that UCSF Health system’s accountable care organizations (ACOs) and other affiliations help their patients receive the right medications and take them the right way … by developing and evaluating pharmacy care and medication management models in the ambulatory care setting.

Driver: Lisa Kroon, PharmD; Marilyn Stebbins, PharmD

With: Daniel Wandres, PharmD

Progress to 2017

The Department of Clinical Pharmacy established new pharmacy services with the UCSF ACO-Hill and Healthnet Blue& Gold in August 2016. We hired a new staff pharmacist, Mackenzie Clark, PharmD, who is providing telehealth and in-person pharmacy services for targeted populations (e.g., high risk, high health care utilizers, chronic disease management—diabetes, hypertension). We will be expanding to the UCSF Hill-Blue Shield ACO population in late 2016/early 2017.

3.1.3

Demonstrate and reinforce the importance of accurate medication lists throughout UCSF Health … by aggressively implementing and assessing the impact of UCSF MedList Clinic services.

Driver: Marilyn Stebbins, PharmD

With: Jennifer Cocohoba, PharmD

Progress to 2017

See 3.1.1. The UCSF MedList Clinic is no longer exists. Other ambulatory care pharmacy initiatives have evolved, based on the principles of the MedList Clinic (e.g., patients having an accurate medication list).

3.1.4

Continually assess formulary management and medication safety and effectiveness at the UCSF Medical Center and across the UC system … by evidence-based medication use research carried out by the UCSF Medication Outcomes Center.

Driver: Bret Brodowy, PharmD

With: Candy Tsourounis, PharmD; UCSF Medical Center medication safety specialists

Progress to 2017

The concept of a UC system wide formulary has been discussed between School of Pharmacy and UC leadership. Bret Brodowy, PharmD, and the Medication Outcomes Center team will be taking initial steps (along with faculty at the UC San Diego School of Pharmacy) to begin benchmarking medication use among UC Medical Centers to uncover differences in approaches regarding the safe, effective, cost-effective use of drugs.

3.1.5

Demonstrate the importance of health information exchange between community pharmacists and other health care providers … by first studying the types and impact of this information exchange.

Driver: Marilyn Stebbins, PharmD

With: Jennifer Cocohoba, PharmD; Lisa Kroon, PharmD; Kevin Rodondi, PharmD

Progress to 2017

Marilyn Stebbins, PharmD and Jennifer Cocohoba, PharmD, are collaborating with Walgreen Outcomes Research team to examine barriers and facilitators of adherence to specialty medications. Phase 1 of this study is conducting interviews and focus groups with providers, patients, and community pharmacists.

We have data from our collaboration with Walgreens that community pharmacists’ access (currently read-only) to a health systems’ electronic medical record allows them to be more involved in patient care services (e.g., facilitation of medication prior authorizations and thus medication access).

3.1.6

Demonstrate the value of pharmacist care services at the UCSF Medical Center… by developing a rigorous outcomes research program in the Medication Outcomes Center.

Driver: Bret Brodowy, PharmD (interim, until Outcomes/Pharmacoeconomics faculty hired)

With: Lisa Kroon, PharmD; Daniel Wandres, PharmD (interim, until Clinical Manager hired)

Progress to 2017

This is a work in progress. The Medication Outcomes Center had one faculty member leave in September 2016. We are about to start a search for two new faculty members with pharmacoeconomic and/or outcomes research expertise. These new recruits will also us to achieve this objective. We did hire a new analyst, Tracy Lin, PhD, who has health economics expertise.

Goal 2: Translate data into more precise medication decisions for individual patients

3.2.1

Interpret medication-related tests—including pharmacogenomics—to assess appropriate medication therapy for patients at UCSF Health … by creating a pharmacist consultation service.

Driver: Ruth Greenblatt, MD

With: Bani Tamraz, PharmD, PhD; Jaekyu Shin, PharmD

Progress to 2017

One of three campus strategic initiative funds ($220,289) was awarded to Bani Tamraz, PharmD, PhD, a junior faculty member in the Department of Clinical Pharmacy, to develop the optimal path for clinical application of pharmacogenetics within UCSF Health. This work lays the foundation for pharmacists to translate pharmacogenetic test results into actionable information for our patients and providers.

Goal 3: Influence policy that affects health science research and patient care

3.3.1

Evaluate the impact on the health of Californians of the new authorities given to pharmacists by California Senate Bill 493 … by collaborating with Healthforce at UCSF and state pharmacy leaders.

Driver: Lisa Kroon, PharmD

With: Kevin Rodondi, PharmD; Outcomes/pharmacoeconomics faculty member to be hired in the Medication Outcomes Center

Progress to 2017

Lisa Kroon, PharmD, is serving as the faculty research preceptor for the Albertsons/Safeway community pharmacy resident, whose research project is the evaluation of users of the hormonal contraception service offered by Albertsons in Oregon and California since early 2016. To date, more than 1,000 prescriptions for hormonal contraception have been furnished by these community pharmacists. We are evaluating the spread of the service throughout Oregon and California at Albertsons pharmacies, number of pharmacists engaged, and the types of patients using the service.


Changes to theme in 2017

Reassigned objectives to new drivers in light of departures, new hires, new leadership appointments.

See original

Go to: Leading Change: Strategic Course 2015–2020