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What is a medical home?
Healthcare in America is changing rapidly. Medical home or otherwise referred to as patient-centered medical home or advanced primary care practice refers to providing comprehensive and coordinated primary care. The medical home care model is transforming how primary care services are structured and delivered to Americans. This patient centered care approach was designed to improve the quality and access to healthcare services.
There are five key elements of the medical home:
Comprehensive or team based care — a team of doctors, nurses, pharmacists, physician assistants and other health care professionals are accountable for managing the healthcare needs of each patient.
Patient-centered — care approach is used to develop lasting relationships with patients and their families. Culture, values, unique needs, and preferences are addressed and patients are involved in their care plans.
Coordinated care — the primary care medical home coordinates with other areas of the health care system such as hospitals, rehabilitation centers, specialty care, and others. Coordination of care is particularly important during transitions in care settings. For example, when patients are discharged from the hospital.
Excellent access to care — services are provided with shorter wait times, after-hours access, and around the clock access to telephone and electronic services.
Quality and safety — ongoing improvements are made to uphold patient safety. Evidence-based medicine is used to deliver care of the highest quality and the whole healthcare team is committed to delivering excellence in patient care.
The role of pharmacists in the medical home model
Pharmacists are well trained healthcare professionals. They are positioned to fill gaps in care caused by a shortage of medical doctors, physician assistants, and nurse practitioners. Although pharmacists are the most accessible healthcare professionals, they are often underused. Pharmacists have the expertise and play an important role in optimizing treatment outcomes, promoting the safe and cost effective use of medications, and improving access to care.
What services do pharmacists provide in the medical home?
Disease management — pharmacists can monitor or change medication regimen using a pre-approved care protocol developed by the care team. After patients have been diagnosed by their primary care physician, follow up visits can be conducted by pharmacists to assess response to treatment. Pharmacists can improve the care of patients with chronic diseases such as diabetes mellitus and hyperlipidemia.
Medication therapy management — pharmacists are medication experts who have the training to promote the safe and effective use of medications. Pharmacists conduct periodic comprehensive medication reviews to identify, resolve, monitor, and prevent medication misuse and safety problems. Patient’s personal medication record is created and pharmacists work closely with patients to determine individual treatment goals and interventions. Pharmacists design action plans with medication recommendations and schedule follow up appointments. Patient care information is shared with the primary care physician to discuss treatment options.
Preventive care — pharmacists have the training to administer immunizations. Furthermore, pharmacists can provide wellness care services and patient education on healthy lifestyle options.
Medication reconciliation — patients with advanced age, those with low health literacy, patients with adherence issues, and chronic diseases require more attention. Pharmacists can fill in the gaps of care by monitoring the progress of these patients and providing individualized care. Pharmacists can design programs that promote health literacy and adherence. They can also address issues of inappropriate medication use and recommend optimal evidence based treatment options and cost-effective therapies.
Have an active role in identifying potential treatments — pharmacists may be involved in pharmaceutical research and approval. They can also influence healthcare policies and serve on drug approval committees.
Secure financial resources — pharmacists can be a part of the healthcare team in securing financial resources by delivering outstanding clinical services.
Administration — pharmacists may also be involved in the accreditation of medical homes.
The role of pharmacists in healthcare is expanding. Pharmacists are in the forefront of patient care and have tremendous opportunities to serve important roles in the patient-centered medical home model. The quality of patient care and medication safety can be improved as pharmacists continue to find their niche in this evolving care setting.
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Defining the PCMH. Patient Centered Medical Home Resource Center.
Ensuring That Patient-Centered Medical Homes Effectively Serve Patients With Complex Health Needs. Patient-Centered Medical Home Decision maker Brief. Agency for Healthcare Research and Quality (AHRQ). Prevention/Care Management.
Expanding Pharmacist Role in Patient-Centered Medical Home. American Association of Colleges of Pharmacy AACP.
Smith M, Bates D, et al. Why Pharmacists Belong In The Medical Home. Health Affairs.
Smith M, Nigro S. The Patient-Centered Medical Home. PSAP-VII Science and Practice of Pharmacotherapy.