The United States' evolving health care quality landscape inspired Telligen, the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) serving Iowa, Illinois and Colorado, to look outside the hospital system for new care perspectives. The organization has fostered relationships among members of local communities to convene leaders from across multiple care domains. More than ever, pharmacists are integral to these new networks.
"Because pharmacy and medication are intrinsically linked, and medication is central to health care, pharmacists are well positioned to impact every stage of care."
“Because pharmacy and medication are intrinsically linked, and medication is central to health care, pharmacists are well positioned to impact every stage of care,” said Katy Brown, Pharm.D., Clinical Pharmacy Specialist at Telligen.
Despite this link, the health care quality improvement field only recently has recognized the impact of pharmacists on the patient experience. Telligen strives to incorporate pharmacists’ perspectives into care initiatives and highlight how their work is meaningful to patient outcomes.
Pharmacists are poised to be influencers, noted Brown, and many of them are already well connected within their own communities. They also hold one of the most trusted professions in the U.S, according to a 2014 Gallup poll. She said they have a strong passion for improving care, but they cannot do it alone. That’s where QIN-QIOs can help.
“They already have a vision of how they can improve outcomes for their patients,” Brown said. “So we’re helping bring the appropriate people to the table as needed. We have data to help them place a value on their work.”
In 2014, an Iowa City outpatient pharmacist requested Telligen’s assistance in building a coalition to expand the reach of medication safety and adherence initiatives. Telligen acted as a convener and consultant for the team of inpatient and community pharmacists, offering guidance on quality improvement principles. Within one month, the group successfully documented 2,000 interventions that took place as a result of its efforts.
This year, the coalition plans to test the Iowa Health Information Network (IHIN), a hub that facilitates sharing of secure electronic patient information. The team will evaluate the service and determine how sharing health information with community providers impacts outcomes.
This shift to a new leadership model is partially attributable to recent health care reforms under the Affordable Care Act and other mandates. The implementation of the Impact Act of 2014 and the introduction of CMS’ Hospital Readmissions Reduction Program have resulted in more health care providers having a stake in avoiding financial penalties associated with high readmission rates.
Kate LaFollette, RN, Senior Quality Improvement Facilitator at Telligen, noted that up to 40 percent of hospital readmissions are medication-related, so mitigating adverse drug events alone could dramatically decrease readmissions in many cases.
However, reducing these events can’t be done by an inpatient pharmacy alone. LaFollette noted that because hospital visits are infrequent for most people, a patient’s information is out of date once they leave the hospital. By contrast, community pharmacies are more likely to have the most current information.
“We spend most of our time in our communities, which is why the community pharmacist’s role is so important,” LaFollette said.
She added that community pharmacists are often the only common factor in a patient’s care regimen. Patients may receive multiple prescriptions from several different physicians through a single pharmacy. Often it is the pharmacist who intervenes, if necessary, by facilitating communication among providers. LaFollette and Brown observed that these collaborative interventions can play an active role in improving patient outcomes and reducing costs related to sub-optimal medication use and adverse drug events.
Telligen believes that with pharmacists at the intersection of care, a pharmacist-led, networked approach is vital to the future of quality improvement. The QIN-QIO plans to continue supporting new relationships and encouraging innovative leaders at the community level.
Brown and LaFollette emphasized that their work is an official acknowledgement of the work pharmacies already do rather than a push to add to pharmacists’ responsibilities. They aim to underscore the value that pharmacists have been bringing to health care for decades and to create a community-wide process that empowers them and illuminates the importance of pharmacies.
“Pharmacists make interventions all the time,” said Brown. “We’re bringing to light how much of an impact they have on the community.”