MDs, pharmacists partner to manage chronic conditions

Education is a key to medication adherence

Northwestern Memorial Physicians Group in Chicago is partnering with Walgreens to counsel patients with chronic illnesses on their disease and medication and to support them in following their medication regimen. So far, patients in the pilot have increased their medication adherence on five different drugs by 5%.

"As primary care providers, we are always looking for innovative ways to help manage the health of the population we serve, and one of the best ways is to collaborate with an organization that has a similar mission and values. We know that chronically ill patients often need extra help in understanding their disease and why they need to take their medications. We chose to work with Walgreens because a large percentage of our patients go to Walgreens to get their prescriptions filled," says Seamus Collins, director of business development and physician affairs for Northwestern Memorial Physicians Group.

The physician group is a wholly owned subsidiary of Northwestern Memorial Hospital. Walgreens has partnered with the hospital for several years to provide prescriptions to patients being discharged through a bedside delivery program and operates an outpatient pharmacy in a medical office building on the hospital campus.

Patients eligible for the program are employees of Northwestern Memorial or Walgreens and use Northwestern Memorial Physicians Group for primary care, as the program is still in the pilot stage. They are automatically enrolled in the program but always have the choice of opting out.

"The potential for this type of partnership is immense," says Lyle Berkowitz, MD, the medical director of information technology and innovation for the physician practice. "Like many primary care groups, we often see our chronic care patients only around four times a year, so having these pharmacists as part of our care team means that we can easily double the number of interactions with them, which can improve education, as well as serve as an early warning system when there are problems," he adds.

Physicians from Northwestern Memorial and pharmacists from the Walgreens clinic worked together to develop the program, says Ron Weinert, vice president of health system services for Walgreens. They chose to concentrate on patients with one or more of four chronic conditions — diabetes, asthma, hypertension, and hyperlipidemia. "Patients with these conditions typically need a lot of support in adjusting to and following their medication regimen," Weinert says.

The physicians and pharmacists collaborated to develop an intervention plan for each disease that includes a series of sessions and questions designed to help patients better understand their disease and adhere to their treatment plan.

The physician group sends a list of eligible patients to the pharmacy every other week. When a person in the program comes into a pharmacy to pick up a prescription, the pharmacy's electronic system alerts the pharmacist. "We welcome the individual into the program, explain additional services, and start the process of educating them on their disease and how to become adherent," Weinert notes.

Each time the patients in the program come into the pharmacy, the pharmacist goes over the patient's prescriptions, educates them on their disease, and asks a series of questions to determine whether the patients understand their conditions and if they are following their treatment plan. A report of the meeting is sent to the care coordination team at the physician practice.

If the answers indicate that the patient is having problems or doesn't understand something, or hasn't taken the medication as prescribed, it triggers an alert to the physician's care coordination team, who notify the physician via the electronic medical record.

"The care coordination team at the physician practice functions as an intermediary between the pharmacy and the physicians. They don't make clinical decisions but they get the physicians the information about the patients in a format and manner that is easy to interpret and react to," Collins adds.

Once the physician has been notified about a problem, he or she may call the patient to clarify what is happening and answer any questions or may ask the care coordination team to schedule an appointment. "All of these actions then create a higher-quality experience for patients," Collins says.