Wednesday, August 10, 2011
Guest Commentary: Collaborative Care's Crucial Role in Population Health
Amanda Solis, MS
Jefferson School of Population Health
A focus on population health requires a creative and collaborative approach to care.
The traditional perspective in healthcare has been fairly physician-focused. As we seek to fulfill the mandate to become more patient-centered in our outlook, it is important to leverage the important roles of pharmacists, physical therapists, nurses, nurse practitioners and physician assistants, health coaches and nutritionists.
To illustrate my point, here is one example of the role a collaborative care team can play in the management of chronic disease that specifically highlights the community pharmacist. Beginning in 2006, the American Pharmacists Association (APhA) launched a program named the “Diabetes Ten City Challenge.” Originally born from the Asheville Project, also conducted by the APhA Foundation and funded by GlaxoSmithKline, this program was aimed at implementing a patient self-management program for diabetes using community-based pharmacies as the base of operations.
The Diabetes Ten City Challenge (DTCC) consisted of 3 main objectives:
1. To implement an employer-funded, collaborative health management program using community-based pharmacist coaching, evidence-based diabetes care guidelines, and self-management strategies designed to keep patients with diabetes healthy and productive.
2. To implement the patient self-management training and assessment credential that equips patients with the knowledge, skills, and performance monitoring priorities needed to actively participate in managing their diabetes.
3. To assess participant satisfaction with overall diabetes care and pharmacist care provided in the program.
Patients in the DTCC program worked with a community pharmacist to develop their knowledge, skills, and performance related to self-management of diabetes. This unique approach established the community pharmacist as a patient coach and leader of the care team. Community pharmacists are in a prime position to serve this role, since they have so much regular contact with patients
DTCC program outcomes included statistically significant improvements in A1C, LDL cholesterol, and systolic and diastolic blood pressure measures. Patients also reported higher rates of influenza vaccinations, and being current in terms of eye and foot examinations.
In addition to improved clinical outcomes, average total health care costs per patient per year were reduced by $1,079 (7.2%) compared with projected costs. Full results and more information can be found here http://www.diabetestencitychallenge.com/index.php.
The DTCC illustrates an important opportunity to shift the model of care, improve health outcomes, and lower cost. As we face a reduction in primary care physicians and an increase in the number of patients with chronic conditions, we need to work toward implementing creative and collaborative solutions to meet the needs of our citizens.