Development and implementation of an interdisciplinary pulmonary care clinic within an existing clinic program

Utilizing diagnostic pharmacists to support Family Medicine Walk-In clinics during the COVID-19 pandemic

Background

During the coronavirus 2019 (COVID-19) pandemic, physician focus shifted from continuity of care to pandemic duties. However, patients still required in-person visits for acute or chronic complaints. Specially trained pharmacists were utilized to alleviate Family Medicine Walk-In (FMWI) provider shortages.

Objective

To describe the innovative practice utilizing diagnostic pharmacists in FMWI, evaluate their impact on provider time, compare workload with traditional advanced practice providers (APPs), and evaluate type of visits and medications prescribed.

Practice description

Pharmacists at an Indian Health Service medical center staffed FMWI 2.5 days per week to alleviate provider shortages during the COVID-19 pandemic. The privileged pharmacist had a diagnostic scope like APPs. Non-privileged pharmacists provided care to patients utilizing current protocols and were required to present all new complaints to providers.

Practice innovation

The facility utilized pharmacists that have completed or were progressing through the local diagnostic training program to alleviate provider shortages.

Evaluation methods

The absolute number of visits by pharmacists was determined and the number of provider hours shifted to pharmacy estimated. The number of visits by provider type was calculated and compared. ICD-10 codes were evaluated for purpose of visits. New prescriptions written by pharmacists were categorized and reimbursement rates determined.

Results

Pharmacists were responsible for 677 visits during 88 clinic days, with an estimated 338 provider hours shifted to pharmacists. Pharmacists saw 5.8 patients per day, APPs 5.2, and physicians 5.7. Pharmacists primarily evaluated hypertension, diabetes, musculoskeletal, and infectious disease complaints. New prescription categories included pain management, endocrine, cardiovascular, and infectious disease. The single billable pharmacist was reimbursed $77,945.

Conclusion

Diagnostic pharmacists in FMWI have allowed providers to shift to other pandemic duties and demonstrate similar workload as APPs. Most visits and prescriptions fall within known pharmacist practice. Pharmacists in this setting pay for the existence of this position and remain integrated in FMWI.

Activating primary care COPD patients with multi-morbidity through tailored self-management support

Given the dearth of COPD self-management interventions that specifically acknowledge multi-morbidity in primary care, we aimed to activate COPD patients through personalised self-management support that recognised the implications of co-morbidities. This single-group experimental study included patients aged 40−84 with a spirometry diagnosis of COPD and at least one co-morbidity. A self-management education programme for COPD in the context of multi-morbidity, based on the Health Belief Model, was tailored and delivered to participants by general practice nurses in face-to-face sessions. At 6 months’ follow-up, there was significant improvement in patient activation (p < 0.001), COPD-related quality of life (p = 0.012), COPD knowledge (p < 0.001) and inhaler device technique (p = 0.001), with no significant change in perception of multi-morbidity (p = 0.822) or COPD-related multi-morbidity (0.084). The programme improved patients’ self-efficacy for their COPD as well as overall health behaviour. The findings form an empirical basis for further testing the programme in a large-scale randomised controlled trial.