Highlights from the CMM Effectiveness and Implementation Grant: A Report from the Study Team

Each quarter, the ACCP Report features a column, written by the study team, to provide ACCP members with highlights and learnings from the comprehensive medication management (CMM) project. The previous reports can be found here: http://www.accp.com/report/archives.aspx.

Study Updates

To revisit the aims of the study, you can find them outlined at http://www.accp.com/061601.

In this quarterly installment, we highlight two aspects of the study related to assessing the value proposition for CMM in primary care: the patient experience with CMM and the provider experience with CMM. The Triple Aim - enhancing patient experience, improving population health, and reducing costs - is widely accepted as a roadmap for improving health care. Many have advocated for expansion of the Triple Aim to the Quadruple Aim to add the goal of improving the health care provider experience. Toward this end, we will be evaluating all components of the Quadruple Aim in seeking to demonstrate the value proposition for medication optimization in improving national health care.

While work continues in our effort to measure the impact of CMM on important quality metrics and cost, we also seek to assess the impact of CMM on patient and provider experience.  This work is key toward building the business case for CMM. These efforts continue through spring 2018 with results available late spring-early summer. We provide a brief overview on the assessment of patient and provider experience.

Patient Experience with CMM

Patient experience with CMM is measured according to a construct we refer to as patient responsiveness. In implementation efforts, it is important to assess the participant's/patient's responsiveness to the intervention or service. We define patient responsiveness around three core components of the patient experience:

• Satisfaction with care: overall satisfaction with the comprehensive medication management service.
• Receiving care that meets the needs of the patient: the patient's evaluation of the CMM service and how well it meets their needs.
• Quality of the patient-pharmacist interaction and relationship: the patient's perception of the quality of their interaction and relationship with the pharmacist.

This assessment is administered as a survey to patients after they have had at least one CMM visit with a clinical pharmacist in a primary care physician office. In addition to assessing impact on care consistent with the Quadruple Aim, the patient experience is serving as an essential element of our multi-faceted approach to assessing fidelity to the CMM intervention. With fidelity of the CMM intervention defined as assuring that the CMM intervention is implemented as intended. A critical aspect of a well-implemented intervention is the patient's perspective, hence, the patient experience or patient responsiveness becomes an important construct of a fidelity assessment.

Not only will we deliver learnings on patient experience with CMM across our study sites, it is our goal to validate an instrument for more widespread use across the profession in assessing patient experience with CMM.

Provider Experience with CMM

Primary care providers (PCPs) (i.e., physicians, nurse practitioners, and physician assistants) are key stakeholders for the effective and efficient delivery of CMM and, as referenced above, provider experience is a key component of the Quadruple Aim for improving patient care and health care quality. PCPs are necessary partners in a patient-centered, team-based care delivery model and have unique insights into the impact of CMM services on their overall experience. Thus, knowing and understanding provider experience with CMM is important as PCPs may contribute to CMM practice advancement, effectiveness, and sustainability. As part of provider experience, provider wellbeing and burnout have emerged as important areas of emphasis across primary care practice in general. Thus, we are interested in understanding the impact of CMM services on PCP wellbeing and burnout. As part of this study, we will a) define the themes described by PCPs regarding how CMM services delivered by clinical pharmacists embedded in primary care clinics affect their clinical functions and professional wellbeing and, overtime, b) develop a validated instrument to assess provider experience with CMM. 

Similar to patient experience, our goal is to deliver learnings on provider experience with CMM across our study sites, and, eventually, validate an instrument for more widespread use across the profession in assessing provider experience with CMM in primary care.

Educational Programming

Please join us in February at the Updates in Therapeutics^® Meeting in Jacksonville, Florida for the new Patient-Centered Team-Based Practice Forum! We have planned an exciting three-day workshop to engage participants in CMM practice advancement and improvement, and will utilize learnings from the study to assist attendees in efforts to accelerate the advancement of CMM in primary care and other ambulatory care clinics. We will also be joined by a number of guest speakers, including clinical pharmacists practicing in ambulatory care clinics throughout the US, physician providers, and other key stakeholders who will speak to payment and policy reform in the context of optimizing medication use. Importantly, as a participant in this workshop, we will actively engage you in assessing your own CMM practice and provide you with tangible tools and opportunities to work alongside others to develop action-oriented plans to accelerate advancement of CMM back at your home practices and organizations.

For maximum savings, register by Friday, January 19. This programming will be available for up to 11.5 hours of continuing pharmacy education. Complete program information and registration details may be found on the ACCP Updates in Therapeutics^® webpage.

On behalf of the investigators and study team, we hope these highlights are informative. Please feel free to reach out to Mary Roth McClurg at [email protected] or Todd Sorensen at [email protected] at any time with questions.