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Clinical Pharmacy Program Wins National Award

Blue Mountain Hospital and Utah Navajo Health System, Inc. have added another unique and valuable service to their arsenal of clinical health care options available for patients in San Juan County.

Since 2011 the Clinical Pharmacy Program has been working hand-in-hand with doctors and nurses, providing education, medication counseling and coordinated health care treatment for UNHS patients. Patients suffering from various forms of diabetes have especially benefitted from the Clinical Pharmacy Program, as have patients who take some forms of anticoagulant medication (blood thinners).

According to Albert Noyes, PharmD, who works with both the hospital and UNHS, the Clinical Pharmacy Program is a practice model in which medication therapy takes a more active role in patient care. Noyes said students enrolled in pharmacy schools must now have additional credentials, and schooling, which allow them to graduate as Doctors of Pharmacy. In years past, pharmacy students earned a Bachelors Degree and could receive a state license, he explained. Now things have changed. Pharmacy students must complete undergraduate work in the basic sciences before spending four years in graduate school, completing a Doctor of Pharmacy Degree.

"In the past ten years everything has shifted," Noyes said. "Part of the reason is the wide explosion of new medications. But just because someone is a Doctor of Pharmacy (or Clinical Pharmacist), doesn't mean that person can replace a regular doctor. We are consultants, like the other specialists who work with patients and a doctor's referral is needed before we work with any patient."

Noyes said it is not common to see a pharmacist practicing in a clinic setting with physicians and nurses, but UNHS has a progressive practice model that stresses a broader team-based approach to patient care. This, he said, allows the clinical pharmacist to meet with patients in the clinic for issues dealing with medication and patient understanding. This model has gained enthusiastic support from UNHS administrators and clinicians, and that support has helped build a collaborative program unique within the State of Utah.

With a referral from a primary provider, clinical pharmacists meet with patients and help them understand better how to care for their conditions, how to take medications safely and effectively, and what else can be done to achieve the best quality of life (like lab tests, follow up appointments and procedures). The Clinical Pharmacist can take extra time with patients, bring in language interpreters and other educational tools to increase knowledge and understanding about their condition. Educational sessions include goal setting with the patient, regarding steps to help manage their condition. Goals can include counseling about changes to medication, lab work or medical follow up. All recommendations from the clinical pharmacist are shared with the patient's primary provider to ensure consistent cooperation among all providers involved in the patient's care.

Noyes also explained an additional layer of responsibility for the clinical pharmacist can be requested by the primary physician, and approved through a document called the collaborative practice agreement (CPA). The CPA allows the clinical pharmacist to assist in directly managing treatment of a specific disorder. UNHS has two CPA's for medication management: Diabetes and Anticoagulation. The CPA's allow the clinical pharmacist to offer a higher-level support for patients who require more intensive follow-up for a period of time, to get control of their condition.

For instance, a diabetes patient who needs to start insulin therapy must have a good understanding of how insulin works and detailed instructions about how to use it safely. Once insulin therapy begins, the dose must be adjusted, several times in some cases, to find the right dose for each patient. The clinical pharmacist coaches the patient through this process of monitoring blood sugar and adjusting doses through frequent follow-up visits, phone calls and emergency counseling at home by phone whenever needed.

Noyes said studies indicate that since the clinical pharmacy program began, trends show that a in sample of UNHS patients with 'uncontrolled" diabetes based on their hemoglobin A1c test (HbA1c) 9% or greater, 24% have lowered their diabetes level from 'uncontrolled' to 'fair' or better controlled (less than 9%). He said the national average, according to the American Diabetes Association, is between 8% and 12%. But there is still a lot of work to be done. Estimates suggest up to 1500 UNHS patients have diabetes, and 24% of the total area population remains 'unknown' regarding their diabetes status.

The same type of clinical pharmacy treatment is being used to help people taking anticoagulants (blood thinners, which Noyes says rank among the top 5 in medication error rates). With a doctor's referral, the clinical pharmacists can also help with medication consultations for conditions like Parkinson's disease, seizure disorders, congestive heart failure, coronary artery disease, chronic kidney disease and more. Clinical pharmacists at Blue Mountain Hospital, working with physician referrals from UNHS, have been able to help patients taking a mixture of medication redundancies prescribed by more than one specialist, which were causing more difficulties than they were helping; educated patients about excessive use of over the counter medications and vitamin supplements and remedied what Noyes called 'polypharmacy' issues.

Dr. Andy Bayles (PharmD), Tyler Gilson (Pharm D) and Angela Konecki (Pharm D) are the other members of the Clinical Pharmacist staff. Having five clinical pharmacists vastly increases the number of UNHS patients they can see, and allows them to bring the clinical pharmacy program to more areas of San Juan County. The Blue Mountain Hospital/UNHS clinical pharmacy program is the only such program in Utah, other than at the University of Utah. The program was recently honored with an award for Patient Safety and Clinical Pharmacy collaboration from the Health Resources and Services Administration for fostering the development of clinical pharmacy models.

"The goal of the clinical pharmacy program is to help improve the quality of patient care and reduce errors in patient care through collaborative practice agreements with our providers," Noyes said.

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Blue Mountain Hospital
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