Location
- Within Community North’s existing geriatric clinic
- Patient’s will be seen in pharmacist’s office for services provided
- Office Hours consistent with physicians: 8 am-5 pm Monday-Friday
Staff
- 1 FTE — full-time pharmacist working 8 am-5 pm Monday-Friday
- Requirements include completion of ambulatory care residency
- Clerical staff already in place with existing clinic
- Will aid in scheduling patients and reminder calls
Referral Process
- Self-referred, referred by a loved one, or primary care physician
- Primary Care Physician Referral Form
- AWV visits recommended by PCP or physicians within clinic
Billing Process
- Annual Wellness Visits (AWV)
- Initial Visit: G0438 ($161.49)
- Subsequent Visits: G0439 ($106.93)
Length of Patient Visits
- 30 minutes for new patient medication review
- Prior to remaining appointment with rest of healthcare team
- Appointments will be in the morning (8 am-12 pm)
- One month follow-up appointment to evaluate successfulness of interventions made and if any new problems have occurred
- Prior to remaining appointment with rest of healthcare team
- One hour for AWV patients
- 45-minute visit with patient, 15 minutes to complete documentation
- Appointments in the afternoon (12:30 pm-4:30 pm)
Pharmacist-Patient Interaction
- Medication review: Our main goal is to improve safety associated with medication use and decrease polypharmacy.
- Patient (and potential caregiver) will meet with the pharmacist within the clinic.
- Pharmacist will begin by explaining the purpose of the visit
- Pharmacist will ask the patient what concerns they have regarding their medications and if they have experienced any side effects
- Pharmacist reviews patient’s disease states and medications prescribed looking to optimize therapy by reducing duplicate therapy and preventing adverse effects
- Pharmacist addresses any patient concerns regarding adverse effects and provides recommendations for remembering medications
- Pill boxes
- Walgreens App Pill Reminder
- Annual Wellness Visits (AWV):
- Establish medical and family history
- Measure vital signs
- Establish list of medical providers
- Cognitive impairment screen
- Depression screen
- Functional status
- Personalized prevention plan
Visit Documentation
- Documentation will be provided in the electronic medical record including:
- Recommendations for adjustment in therapy
- Interventions for patient compliance
- Information can also be provided to primary care physician if not located within the hospital per patient approval
- Annual wellness visit documentation
Scheduling/No-Show Plan
- Patient’s will schedule appointments through clerical staff
- Pharmacist will call patient 2 days prior to appointment to build confidence in the service provided
- Cancellations by the patient must be done at least 24 hours prior to appointment
- A 1-time cancellation 24 hours prior to appointment will result in no charge to the patient
- Two or more cancellations by patient will result in a $25 charge to the patient per visit missed
Data Measures
- Subjective measures:
- Patient satisfaction surveys
- How many adverse effects did the patient experience prior to first appointment, compared to how many they experience at follow-up appointment in one month
- Has the patient’s medication adherence improved
- How many interventions did the pharmacist recommend to the physician
- Annual Wellness Visits
- Patient satisfaction survey given at the conclusion of the visit:
- Comfort and satisfaction with pharmacist administering AWV
- Perceived importance of AWV to overall health
- Intended lifestyle changes that will be made after AWV
- Perceived strengths and areas in need of improvement
- Patient satisfaction survey given at the conclusion of the visit:
CDTM Protocol
- Throughout the pilot program, the pharmacist will recommend changes to therapy to geriatrician/nurse practitioner and/or primary care physician. Once the pharmacist has determined their role in the clinic more clearly, a collaborative practice agreement can be created.