Integrating Innovative Telehealth Solutions into an Interprofessional Team-Delivered Chronic Care Management Pilot Program
Integrating Innovative Telehealth Solutions into an Interprofessional Team-Delivered Chronic Care Management Pilot Program
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DOI：
10.18553/jmcp.2018.24.8.813
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发表时间：
2018-08-01
影响因子：
2.1
通讯作者：
Warholak, Terri L.
中科院分区：
文献类型：
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作者：
Taylor, Ann M.;Bingham, Jennifer;Warholak, Terri L.
背景技术背景：药剂师提供的药物治疗管理（MTM）服务可以改善患者的治疗效果，但对门诊、跨专业远程药物治疗程序知之甚少。目的：评估门诊、跨专业远程慢性病护理管理（CCM）试点程序。这个为期6个月的计划整合了家庭医学提供者，一个以大学为基础的药物管理远程药剂师，和跨专业护理协调员使用远程医疗解决方案的CCM和药房教育服务。一名医生将有药物相关问题风险的患者转介给远程药剂师。符合条件的患者患有3种或3种以上慢性疾病或服用至少5种药物，年龄在18岁及以上，并且在计划期间至少与他们的初级保健提供者有1次预约。护理协调员亲自会见病人，以促进这些虚拟诊所的过程。远程药剂师通过视频会议技术进行全面的药物审查（CMR），根据初步诊断、当前药物和过敏、实验室结果和既往病历记录提供CCM。该咨询记录在电子健康记录（EHR）提供商审查和修改在真实的time.Results：69例患者接受远程药房咨询和现场注册护士的支持在该计划。大多数患者为女性（56.5%）、年龄51-70岁（60.1%）、白人（72.4%）和非西班牙裔/拉丁裔（71.0%）。患者有1-9种慢性疾病，如高血压（82.6%）、糖尿病（56.5%）、高脂血症（31.9%）、抑郁症（30.4%）和骨质疏松症（29.0%）。大多数患者（94.2%）至少服用5种慢性疾病药物，如他汀类药物（11.2%）、非甾体抗炎药（8.4%）、选择性5-羟色胺再摄取抑制剂（6.5%）、β受体阻滞剂（6.5%）和钙通道阻滞剂（5.6%）。远程药剂师完成了200项干预措施，包括安全性（49.0%）、疫苗（24.5%）、根据国家共识指南的护理差距（13.5%）、依从性（10.0%）和成本节约（3.0%）。患者提供者接受了三分之一（n = 75，37.5%）的远程药剂师建议（例如，监测和药物变化）。结论：这远程保健计划构成了一个附加的服务，同时填补了现场药剂师咨询服务的空白。整合远程药师和注册护士是至关重要的临床服务提供。结果令人鼓舞;然而，必须进行更多的研究，审查远程保健服务在接触得不到充分服务的人口、改善病人护理和降低保健费用方面的有效性。版权所有（C）2018，管理护理药房学院. All rights reserved.
BACKGROUND: Pharmacist-delivered medication therapy management (MTM) services can improve patient outcomes, yet little is known about outpatient, interprofessional telepharmacy programs.OBJECTIVE: To evaluate an outpatient, interprofessional telehealth chronic care management (CCM) pilot program.METHODS: This 6-month program integrated family medicine providers, a university-based medication management telepharmacist, and an interprofessional care coordinator using telehealth solutions for CCM and pharmacy education services. A physician referred patients at risk for medicine-related problems to the telepharmacist. Eligible patients had 3 or more chronic conditions or took at least 5 medications, were aged 18 years and older, and had at least 1 appointment with their primary care provider during the program. The care coordinator met patients in person to facilitate these virtual clinic processes. The telepharmacist conducted a comprehensive medication review (CMR) via video-conferencing technology, providing CCM based on primary diagnosis, current medications and allergies, laboratory results, and previous chart notes. The consultation was documented in the electronic health record (EHR) for provider review and modification in real time.RESULTS: 69 patients received telepharmacy consultations and on-site registered nurse support during the program. Most patients were female (56.5%), aged 51-70 years (60.1%), Caucasian (72.4%), and non-Hispanic/Latino (71.0%). Patients had 1-9 chronic conditions, such as hypertension (82.6%), diabetes (56.5%), hyperlipidemia (31.9%), depression (30.4%), and osteoporosis (29.0%). Most patients (94.2%) took at least 5 chronic disease medications, such as statins (11.2%), nonsteroidal anti-inflammatory drugs (8.4%), selective serotonin reuptake inhibitors (6.5%), beta blockers (6.5%), and calcium channel blockers (5.6%). The telepharmacist completed 200 interventions for safety (49.0%), vaccines (24.5%), care gaps per national consensus guidelines (13.5%), adherence (10.0%), and cost savings (3.0%). Patients' providers accepted one third (n = 75, 37.5%) of the telepharmacist recommendations (e.g., monitoring and medication changes).CONCLUSIONS: This telehealth program constituted an added service for patients while simultaneously filling a gap in on-site pharmacist counseling services. Integrating the telepharmacist and registered nurse was crucial to clinical service provision. The results are encouraging; however, more research must examine the effectiveness of telehealth services in reaching underserved populations, improving patient care, and decreasing health care costs. Copyright (C) 2018, Academy of Managed Care Pharmacy. All rights reserved.