Clinical Research Oriented Workshop (CROW) Meeting: February 2, 2012

Present: Abby Crocker, Kairn Kelley, Amanda Kennedy, Ben Littenberg, Connie van Eeghen

1. Start Up: Amanda had a great vacation and got her camera back from the taxi she left it in – hooray! Many stories about what we’ve left where, what happens, and what happens when it’s on purpose (i.e. as part of a study).

2. Presentation: Amanda gave an update on pharmacists integrated into primary care practices as part of a VDH-funded grant.

a. Plan: five sites, with a part time pharmacist in each one. The goal is to use existing pharmaceutical resources (health organizations, community), with the likelihood of assigning those resources to more than one practice (1:5). Sites were “cherry picked” to ensure 100% commitment. This was a rocky process, as the budget was set before the process was determined.

b. FAHC pharmacy leader today volunteered another .20 FTE to support a sixth practice. Monday, January 30, saw the kick-off meeting, attended by almost all physician leaders.

c. Current timeline: now interviewing pharmacists and selecting them for assignment. Steps to implement:

i. Pharmacist shadows physician, and understands practice flow

ii. Amanda negotiates what actions pharmacists will start with:

1. Education (answer questions from community, staff, CHIT…)

2. Direct patient care (pharmacists can bill for this)

a. Recommendations of Rx to doctor

b. Adjustment of meds based on a pre-set algorithm

c. Re-write Rx (true collaborative practice) – some details need to be worked out here, based on laws, systems, and practice

3. Consultation (see next item) – using the data system to identify patients who need a change in medication intervention.

d. Implications: the pharmacist is not seen as a care manager but as a consultant. One approach is to use the EHR to clean up the practice’s medication management. The pharmacist can look for patterns of medication management and for patients who need follow-up on out-dated or needed meds.

e. Future: one year to explore; in one year will need a sustainability plan. For now: how to integrate into the practice, negotiating with the practice providers/leaders. Amanda is budgeted at 20% of her time, which already appears too low.

i. April: start up with pharmacist, continue for a year

ii. July 2013: analyze data and determine level of success

f. Evaluation plan: mostly process measures. Not a clinical trial, this project is organized under the model of the Blueprint. The focus of the work will be determined by the practice. No one primary outcome; a ‘wacky’ project but very exciting.

i. Clinical measures: meds and changes made

1. Medication Management System is an example of a vendor that can support the pharmacists work, to be copied into the EHR

2. Web-based system might be financially viable, with limited access (not all pharmacists will use at the same time)

ii. Satisfaction: prescriber, staff, pharmacist, patient

iii. Cost: estimates of time spent by pharmacist, costs related to drug changes, diary study of providers to study efficiency

iv. Sustainability: proportion of time that the pharmacists could bill for

3. Workshop Goals for 2012:

a. Journal club: identify UVM guests and articles; invite to CROW ahead of time

b. Research updates: share work-in-process

4. Next Workshop Meeting(s): Thursday, 1:00 p.m. – 2:30 p.m., at Given Courtyard Level 4.

a. Feb 9: Connie: oral presentation for defense (no Ben)

b. Feb 16: Abby: feedback from lit review – new edited version (no Connie)

c. Feb 23: Kairn: lit review update (no Amanda or Connie)

d. Mar 1: (no Connie, ? Kairn)

e. Mar 8: Early start, for those available, 11:00 – 2:00, Connie’s dissertation defense

f. Mar 15: (no Ben, Connie)

g. Future agenda to consider:

i. Ben: budgeting exercise for grant applications

ii. Rodger: Mixed methods article; article on Behavior’s Influence on Medical Conditions (unpublished); drug company funding. Also: discuss design for PCBH clinical and cost research.

iii. Amanda: presentation and interpretation of data in articles

iv. Sharon Henry: article by Cleland, Thoracic Spine Manipulation, Physical Therapy 2007

v. Future: Review of different types of journal articles (lit review, case study, original article, letter to editor…), when each is appropriate, tips on planning/writing (Abby)

Recorder: C. van Eeghen