Lipton argues for pharmacists in the medical home

"As the nation once again engages in discussions of health reform, issues of quality and cost containment are high on the agenda," writes Helene Levens Lipton, PhD, of the University of California, San Francisco, School of Pharmacy, in an editorial in the November 23, 2009 issue of the Archives of Internal Medicine. "One approach to addressing these challenges is team-based delivery of health care services, including physicians and allied health professionals working collaboratively."

In addition to Carter, et. al.'s report on collaboration with pharmacists, two other reports in this issue investigate allied health providers' impact on patient care. A randomized clinical trial conducted by Jun Ma, MD, PhD, of the Palo Alto Medical Foundation Research Institute, California, and colleagues assessed a county health care system program in which nurses and dieticians helped manage cases to reduce cardiovascular risk. In addition, Paul C. Walker, PharmD, of the University of Michigan, Ann Arbor, and colleagues evaluated the addition of a pharmacist to the team caring for patients discharged from general medical services of an academic medical center.

"The results of the three articles in this issue of the Archives, in the context of available literature, make the case that team-based interventions enhance quality of care and improve clinical outcomes, with mixed effects on medical service use and costs," Lipton writes. "The medical home—a model of comprehensive health care delivery and payment reform that emphasizes the central role of primary care—offers opportunities to implement team-based care and systematically and rigorously evaluate its effects on quality and costs."

"The baby boomers—beneficiaries of medical and public health advances that have led to increased life expectancy, and concomitantly, chronic medical conditions—will be placing increased demands on our health delivery system," Lipton concludes. "Among the changes that are needed to improve the quality and cost-effectiveness of their care, and in fact, to keep them in their own homes longer, the medical home is a promising innovation that can fuel advancements in team-based chronic disease management."