Program Description

Mission/Vision: 

  • Our health-care system carries forth Christ’s healing ministry and strengthens the Catholic health care mission by:
    • Providing a broad, coordinated continuum of health care services with an emphasis on improving the health of persons and communities.
    • Treating the mind, body and spirit with holistic and comprehensive medical options.
    • Developing creative structures for health care delivery.
    • Being advocates for those in need.
    • Identifying and developing our sisters and laity for Franciscan leadership.

 

  • At our clinic we are looking to incorporate Franciscan Health’s vision statement into the services provided to our patients in the diabetes clinic
  • Our purpose is to educate Type II Diabetes patients on their disease state, medication therapy, and the use of diabetes testing supplies and medication delivery devices.
  • This clinic will address the problem of an steep increase in patients at the Diabetes & Endocrinology Center without the increase in physicians and diabetes specialists at the center. Pharmacists will be able to meet with patients for an adequate amount of time to discuss their disease state and medications that other healthcare professions may not have.

Location:

  • Franciscan Physician Network Diabetes & Endocrinology Center, located at 5230A E. Stop 11 Road, Suite 150, Indianapolis, IN 46237.
  • The Diabetes & Endocrinology Center is a single floor in a multi-service medical facility.
  • The pharmacist’s office will be in a cubicle by the nurse station on the same floor as the clinic.
  • The pharmacist will utilize a single exam room held vacant during the duration of the ambulatory care clinic’s hours of operation in order to be utilized by the pharmacist or resident on-duty.
  • If a pharmacist and resident are seeing patients at the same time, a second exam room will be utilized during those hours.
  • The hours of operation for the ambulatory care clinic will be 12-4pm, Monday-Thursday.

Staff: 

  • Current Franciscan Health pharmacists will have an expansion of their current roles to fill this position.
  • Two pharmacists, ambulatory care pharmacist Kendra Malone and transition to care pharmacist Kevin Buehrle, will both work two half-days a week, roughly 8 hours per pharmacist per week.
  • Three PGY1 residents with Franciscan Health may see additional patients on their own one half-day a week a piece, increasing time to interact with patients by 12 hours.
  • Pharmacy staff requirements include a PGY1 and PGY2 residency in ambulatory care, pharmacotherapy, transitions of care, internal medicine, or equivalent experience.
  • It is also strongly preferred the pharmacist has a BCACP Board Certification.  
  • The pharmacist will work closely with the multidisciplinary team to optimize patient care.
  • The pharmacist on-duty will see five patients a day, with the last thirty minutes a day consisting of follow-up phone calls to the patients and physicians.
  • Residents will also meet with four patients a day and utilize the last hour to observe patients with the pharmacist or conduct follow-up phone calls.
  • A total of nine patients will be seen three days of the week, and five patients on the day a resident is not in the clinic, for a total of 32 patients a week.

Referral: 

  • Referral criteria: newly diagnosed Type II Diabetes Mellitus patients post-discharge from the hospital, and Type II DM patients with AIC > 9% who have not been seen by a diabetes specialist
  • Patients will be referred by Franciscan Health inpatient pharmacists, inpatient physicians, nurses, primary care providers, or self-referral if the patient meets the requirements to meet with a pharmacist.
  • The medical professional referring the patient will contact the pharmacist through secure Franciscan Health email or via phone call.
  • The patient interested in self-referral will ask their physician about the service, who will then contact the pharmacist. Once the pharmacist receives the referral, he/she will make his/her own schedule and follow up with the patient.

Billing: 

  • G0463 is the new billing service from CMS that covers all outpatient hospital clinic visits regardless of complexity of services provided.

Patient Visits:

  • The patient’s first initial visit will be 45 minutes long.
    • The visit will consist of a meet-and-greet with the patient and pharmacist or resident.
    • The pharmacist will ask the patient what he/she hopes to get out of the appointments, establish SMART goals, and create a plan of action.
    • The patient will receive education on their Type II Diabetes Mellitus including:
      • Information about the disease
      • Diet
      • Exercise
      • Receive a blood glucose log
      • Practice with medication demos 
      • Review the patient’s medications.
    • The patient will receive hand-outs and pamphlets to take home and utilize until their next appointment.
  • The patient will then be scheduled three months later with a follow-up phone call once a month until the next appointment.
  • If the pharmacist feels a patient should be seen sooner, the phone calls will be substituted with a monthly visit.
  • The follow-up visits will be also be 45 minutes long and be a question-answer format with the patient.
    • The pharmacist will:
      • Provide more disease information
      • Review their blood glucose logs
      • Evaluate what the patient is struggling with most
      • See how well they are following their diet and exercise plan 
      • Recommend annual eye and foot exams
    • The following measures will be taken by the pharmacist every visit:
      • Blood pressure
      • Blood glucose
      • Height and weight
      • A1C will be taken only every three months
  • Patients will continue to see the pharmacist once every three months with monthly phone calls until patient’s individualized goals have been met, the patient no longer wants to participate in the service, or the patient is non-compliant to the recommendations after one year and thus discharged from the service.

Documentation: 

  • After each meeting with a referred patient, thorough documentation should be made on the patient’s disease state and what occurred at the appointment.
  • Documentation time is allotted into the 45 minute appointment.
  • Records will be kept on the Franciscan Health Electronic Medical Record system EPIC.
  • All medical personnel within Franciscan Health have access to the records in EPIC and may follow up with the patient as he/she wishes.
  • The pharmacist will follow up with the patient’s physician via secure email or phone call for physicians not readily available in the clinic as soon as the patient’s appointment is completed to discuss recommendations and the disease state of the patient.

Scheduling/Attendance Policy:

  • If a patient misses an appointment, the pharmacist will call the patient to reschedule their appointment. If they miss three appointments, they will be discharged from the Franciscan Health Diabetes & Endocrinology Ambulatory Care Clinic and no further appointments will be made.

Data Collection:

  • Data will be collected every week prospectively.
  • The pharmacist will chart A1C levels, patient weight for trends in weight loss or control, and hospital readmissions. The pharmacist will also document when the patient receives their annual eye and foot exam.
  • Data will also include the patient’s payor to provide data to the Franciscan Health ACO.
  • The patient will take a survey after each patient appointment to gauge patient satisfaction, improved quality of life and general knowledge of their disease state.
  • The pharmacist will be in charge of printing the reports Franciscan Health supplies and creating an Excel spreadsheet with the trends of the patients.
  • Once significant data has been collected over the course of one year, a presentation will be given to the Franciscan Health finance department, P & T committee, CFO, Internal Medicine department, and Diabetes & Endocrinology Center’s specialists and staff to show the results of the pilot program and propose an expansion of the service.
  • Ambulatory care follow up survey

Goals:

  • Optimize medication therapy
  • Educate patient’s about their disease state – personalized care
  • Reduce patient’s A1C
  • Expand the service by hiring full time pharmacist for the clinic
  • Meet patient satisfaction benchmarks that align with Fransican Health’s mission and vision
  • Establish a collaborative practice agreement once practice has been established

About Us. Franciscan Health website. https://www.franciscanhealth.org/about-us. Accessed February 8, 2017.