Improvement of pharmacist role through
coordination of interprofessional pathways
A solution for better treatment adherence
The Value Proposition – Chronic Disease Management
October 13th, 2016 Canada’s Research-Based Phamaceutical Companies
What we will cover today
 Definition of a key challenge for the healthcare
system
 Consensual strategy to tackle this challenge
 The evolution of the role of the pharmacist
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Concerto: Building partnerships
between stakeholders
 Concerto
 Founded by 3 people who work in the health system
 Operated by MDs, nurses and health managers
 Developed a replicable multi-stakeholders partnership model
to better manage population health
 Using the Family Practice Centre as the pivotal point of care
 The project:
 Implemented and operational (25 GP’s)
 Governance model involving industry, government and clinicians
 Results: ahead of expectations – vetted by an objective 3rd party
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The partnership model: funding principles
Concerto
Knowledge transfer
Dashboard
Maturity Index and
Conversion plan expertise
Gov’t & HA
Pharma Industry
HC providers relocated in FPC
Implementation
Training and Coaching
Programs
Family
Practice
Center
Chronic Disease Management
System
Clinical pathways
Well-informed patients
and loved ones who are
partners in care giving
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Complex challenge to meet
 Complex chronic patients:
 Large portion of population suffering from more than one
chronic disease (CD):
 25% of total population: 2+ CD
 40% of adult population: 2+ CD
 CD related costs: 75% of total healthcare budget
 Healthcare system highly fragmented and confined resulting
in uncoordinated care
 Large toll of avoidable complications
 Avoidable emergency visits and hospital stays
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Chronic Care Model
Concerto Health Model: better coordinated care
• Implemented in primary care and
connected to hospitals and
community ressources
• Based on Chronic Care Model by
Wagner
• Elements of Patient Centered
Medical Home
• Canadianized and tested
Better care:
• Patient categorization
• Personalized care
• Evidence-based health protocols
Coordinated care:
• Implementing interdisciplinary teams
• Training and coaching
• Using standardized clinical pathways
• Empowering the patient
*Individualized Interdisciplinary
Intervention Plan
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Role transformation – interdisciplinary team
 Interdisciplinary team
 Customize health care
 Optimize family physician, pharmacist and nurse
threesome (ongoing collaboration)
 Enhance expertise of each profession
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Role transformation – the pharmacist
 Make a pharmacological review
 Initiate or adjust, according to the prescription, the drug
therapy taking into account the laboratory results
 Issue a full report including recommendations to the
clinical team to optimize the patient's medication
 Ensure consistent follow-ups
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Volume of clinical activities per period
Total clientele
700
600
500
400
300
200
100
0
1
2
Nouveaux patients 102 125
Patients traités
3
4
5
6
7
59
54
60
82
48
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
106 117 120
66
78
129 114 110
92
115 105 125 140 121 115
102 149 106 165 156 253 168 280 282 348 215 343 409 409 426 370 423 414 536 642 540 620
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…and providing visibility of population health
targets
Table showing the change in health outcomes based on HbA1C
(1st period, 0 – 6months after the first measure)
21,95 % of patients improved their result.
28,3 % of patients maintained their result at the target level.
37,9 % of patients remained stable, but not at the target level.
11,8 % of patients saw their state of health deteriorate.
HbA1c value : (target = < 7 %, level 1 > 7% < 9 %, level 2 = > 9 % (one or the other)
Example of data gathered on a 18-month period
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Providing visibility of population health targets
Table showing the change in health outcomes based on blood pressure
(2nd period, 6 – 12 months after the first measure)
11.37% of patients improved their result.
74.8% of patients maintained their result at the target level.
5.15% of patients remained stable, but not at the target level.
8.64% of patients saw their state of health deteriorate.
BP value : (target < 140/90, level 1 = (140-159)/(90-99), level 2 > 160/>100 (one or the other)
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13
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Constraints and strategies
 Investing in the front line for gains in 2nd line: frequent flyers
 Resistance to change: validation and sharing of targets,
motivations and strategies - coaching and change
management
 Sharing of roles: valuation of each practice by focusing on the
specific expertise of each profession
 New approaches: continuous quality improvement with
indicators on processes and impacts (clinical results and
other)
15
Pharmacist
Pharmaco
therapeutic
management
Doctor
Diagnosis
and
treatment
Coordination
of care
Therapeutic
education
Clinical nurse
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Professions legal framework (Quebec example)
Minister of Justice
Professionnal Code
Office des professions du
Québec
Québec Interprofessionnal
Council
Professionnal Orders
(46 orders, amongst them 22
health and human relations
related professions)
hierarchical
Medical Act
Pharmacy Act
counsel
17
Professions legal framework
Medical Act
Exclusive profession
(…) no person may engage in any activity
described in the second paragraph of section
31, unless he is a physician.
This section does not apply to the activities
engaged in:(a) by a person in accordance
with the provisions of a regulation adopted
pursuant to paragraph h of section 94 of the
Professional Code
Pharmacy Act
Exclusive profession
(…) no person may engage in any of the
activities described in the second and third
paragraphs of section 17 unless he is a
pharmacist.
This section shall not apply to the activities
engaged in:
(…) (b) by a person in accordance with the
provisions of a regulation adopted pursuant
to paragraph h of section 94 of the
Professional Code