Development and Implementation of a Collaboration between a Patient-Centered Medical Home and Community Pharmacy

Abstract Objective Describe the development and implementation strategies used in the collaboration between a patient-centered medical home (PCMH) and a grocery pharmacy chain. Evaluate the effectiveness of a community pharmacist's clinical integration at reducing hemoglobin A1c values on a clinic- and patient-level. Setting The Kroger Company and CHI St. Vincent Practice Description The Kroger Co. is a large grocery store that operates 27 pharmacies in the state of Arkansas with 20 locations in the central Arkansas area. The PCMH is part of a large health system in central Arkansas with 10 primary care clinics in the area. Practice Innovation With the transition to value-based payment models, pharmacists are being utilized in settings outside of the pharmacy. This project demonstrates a partnership between a community pharmacy and a PCMH. The community pharmacist spent 20 hours per week in the PCMH providing medication therapy and disease state management services. Services were focused on patients with uncontrolled diabetes. Evaluation Descriptive statistics were used to describe the distribution of the pharmacists' time. A patient-level pre-post analysis of the mean changes in hemoglobin A1c (HbA1c) was conducted for patients that interacted directly with the pharmacist. A clinic-level analysis evaluated changes in HbA1c compared to a non-equivalent control group using a standard quality measure. Results Three hundred and twelve individual patients interacted with the pharmacist. Two hundred and twenty-eight of those patients had diabetes. One hundred and eleven patients had pre and post HbA1c. There was a statistically significant reduction in mean HbA1c for those patients with a pre and post HbA1c. Clinic-level results were not statistically significant between the intervention and control locations. Conclusion This project indicates that collaboration between a community pharmacy and PCMH is feasible and may improve patient care. Future research includes exploring pharmacy-based visits and development of process for improved communication.