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ACCP Report - September 2017

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


Each quarter, the ACCP Report features a column, written by our study team, to provide members with highlights and learnings from the comprehensive medication management (CMM) project. The previous reports for January, March, June, and September 2016 and March and June 2017 can be found on the ACCP website.

The report provides an update on study progress and concludes with Research Insights, which highlight a particular aspect of our work. The goal is to share key learnings emerging from our efforts.

Study Updates

To revisit the aims of the study, you can find them outlined here.

In this quarterly installment, we provide updates on study progress and highlight the outcomes of recent in-person meetings held with our 36 sites. We close with information on forthcoming educational programming pertaining to learnings from the project.

In the June 2017 ACCP Report, we provided an overview on the use of implementation science in defining the three core components of CMM: (1) the philosophy of practice, (2) the CMM patient care process, and (3) the structural and system-level elements (i.e., CMM practice management) that allow for integrating and managing the CMM service within a primary care practice. If you have not reviewed the June 2017 ACCP Report, we encourage you to do so because these learnings lay the foundation for CMM. As mentioned in the previous report, we continue to convene our Grant Steering Committee and our Payer and Policy Advisory Board, both of which are composed of national leaders and researchers in CMM, primary care, implementation science, and health care policy and payment. Throughout the project, we share progress and insights and receive input on the strategic direction of the project and dissemination of findings.

In addition, our work continues to extend across many different facets of understanding, implementing, and justifying CMM services in primary care settings. Areas of ongoing work within the CMM grant include:

  • Measuring the impact of CMM on clinical quality measures, health care costs, and the return on investment that can be realized from CMM (aim 4 of our study). This work continues through spring 2018, with updates to be provided in October 2017 at the Annual Meeting;
  • Evaluating the role of a defined process of improvement cycles for scaling up the delivery of CMM services;
  • Developing, implementing, and validating a measure of fidelity to CMM;
  • Assessing provider perception of the value and influence of CMM on medical provider well-being in primary are settings;
  • Developing strategies for deploying resources to accelerate CMM implementation and practice improvement; and
  • Assessing patient engagement and satisfaction with CMM services.

Research Insights: Summer 2017 In-Person Meetings with Our Practice Sites

In July 2017, we convened an in-person meeting in Minnesota for our five in-state health-system sites as well as the New York and New Mexico sites participating in our CMM study. This meeting brought together 40 clinical pharmacists and study personnel. We held a similar meeting in August 2017 in North Carolina for our study sites located throughout the state. This meeting brought together 20 clinical pharmacists and study personnel. Throughout the daylong event in Minnesota and North Carolina, colleagues at the sites engaged in facilitated large-group discussions and small-group learning roundtables. The goals for the meetings were several-fold:

  • Create an opportunity for clinical pharmacists to interact with each other so that experiences as well as strategies for practice improvement can be shared across individuals and practice sites;
  • Continue efforts to build a full understanding among colleagues at all sites of the about how their work is contributing to study aims, yielding relevant findings, and ultimately creating lessons and resources that will help propel the adoption and expansion of CMM services in primary care;
  • Engage clinical pharmacists in more in-depth application of both the CMM patient care process tool and the CMM practice management tool in an effort to gather additional insight and finalize the tools for more widespread use; and
  • Ensure that everyone has an understanding of the activities that will take us to the end of the study as well as the efforts to scale and sustain CMM services beyond the study.

Collectively, the following insights and outcomes emerged from the meetings:

  • Usefulness and importance of the practice management tool (i.e., the structural and system-level elements that allow for the integration and management of the CMM service within a primary care practice): Groups placed high value on the practice management tool that resulted from months of qualitative research and found this tool useful in assessing their own practice supports and identifying more system-level opportunities for improvement. Site colleagues felt the practice management tool would be an invaluable resource for clinical pharmacists and practice sites moving forward. In addition, site colleagues believed the tool beneficial as an educational resource in training pharmacy students and residents. Over the past year, site colleagues have engaged in a series of interviews and cohort discussions that have led to the development of five key domains for practice management. This research culminated not only in a framework for approaching practice management, but also a self-assessment tool to guide practice sites and clinical pharmacists. Findings from this work will be presented at the ACCP 2017 Annual Meeting in Phoenix (see below).
  • Refinement of the CMM patient care process common language: Focus groups were held with the North Carolina sites to complete a final round of qualitative work necessary to finalize the CMM patient care process common language document. This discussion helped refine some key operational definitions within the tool. Throughout the exercise, site colleagues expressed the importance of this tool to guide clinical practice and its relevance and importance in the education and training of students and residents.
  • Appreciation for the role of improvement cycle work: The Plan-Do-Study-Act (PDSA) cycles that have been ongoing throughout the study were of value to our sites. Engagement in the improvement cycle work triggered documented change within sites, and the PDSA resources, tools, and coaching available to them provided a structure for change that they had not previously experienced. A key learning for us was the relative importance and perceived value that sites place on improvement cycles as key to future practice advancement efforts. Findings from this work will also be presented at the 2017 ACCP Annual Meeting. In addition, we are packaging our learnings and resources into an “implementation system” to support practice advancement efforts for profession-wide use beyond the study.
  • The benefit of a learning community: Clinical pharmacists at both events expressed value in engaging face to face with colleagues across various practice sites. Practitioners shared learnings with each other from their experience throughout the study as well as insights into how they are approaching the delivery of CMM and practice improvement within their own practices. These exchanges and the sense of a “community” were a major benefit and were important to our sites.
  • Appreciation for the big picture: Finally, colleagues at the sites appreciated a recap on where we have been, the work that remains to be done, and the efforts to scale and sustain CMM services beyond the study.

We are grateful for the dedication, patience, and commitment of the clinical pharmacists engaged in this study, without which this work and the emerging learnings would not be possible. On behalf of the investigators and study team, we hope these highlights are informative. Please feel free to contact Mary Roth McClurg at mroth@unc.edu or Todd Sorensen at soren042@umn.edu at any time with questions.

Upcoming Presentations and Educational Programming

Opportunities to learn more about the study and engage in practice advancement and improvement workshops include:

2017 ACCP Annual Meeting Poster Presentations

The following abstracts were accepted for poster presentation at the 2017 Annual Meeting in Phoenix.

  • Mendkoff J, Pestka DL, Frail CK, Sorge LA, Funk KA, Carroll J, Sorensen TD, Roth McClurg M. Assessing the State of Comprehensive Medication Management in a Sample of Primary Care Clinics.
  • Pestka DL, Sorge LA, Roth McClurg M, Frail CK, Funk KA, Sorensen TD. The Philosophy of Practice of Comprehensive Medication Management: Evaluating its Meaning and Application in Practice.
  • Pestka DL, Frail CK, Sorge LA, Funk KA, Roth McClurg M, Sorensen TD. Developing a Tool to Assess the Essential Components of Practice Management for Comprehensive Medication Management within Primary Care Clinics.
  • Blanchard C, Frail CK., Funk KA., Livet M, Ward C, Sorensen TD, Roth McClurg M. Assessing fidelity through a comprehensive medication management self-assessment tool.
  • Frail CK, Blanchard C, Livet M, Ward C, Sorensen TD, Roth McClurg M. Developing a Fidelity Assessment System for a Comprehensive Medication Management Service.
  • Livet M, Sorge L, Blanchard C, Ward C, Roth McClurg M, Sorensen TD. The Role of Improvement Cycles in Scaling Up Delivery of Comprehensive Medication Management (CMM) in Primary Care Settings.

2017 ACCP Annual Meeting Educational Programming

Scaling and Sustaining CMM: Findings to Date from the CMM in Primary Care Study Saturday, October 7, 2017, 1:45 p.m. – 3:45 p.m.

ACCP Updates in Therapeutics®, February 16–18, 2018, Jacksonville, Florida

Patient-Centered, Team-Based Care: Focus on Outpatient Practice. Accelerating the Adoption and Sustainability of Comprehensive Medication Management. This is a 3-day interactive workshop designed to:

  • Engage participants in a multifaceted workshop-style event that immerses ambulatory care practitioners in the foundational elements of CMM and prepare them for initial or continued implementation of CMM services;
  • Highlight tools, strategies, and “lessons learned” produced by the “Implementation and Effectiveness of CMM in Primary Care” study;
  • Guide participants in establishing an aim specific for their home organization to drive the adoption and expansion of CMM. Participants will also establish an initial action plan to put implementation efforts on a path that will achieve the defined aim;
  • Guide participants in developing a business case for scaling and sustaining CMM services;
  • Provide the foundation for a longitudinal learning experience that connects learning and coaching to real-time practice implementation and improvement; and
  • Share CMM research and best practices through poster presentation sessions and discussion.

The target audience is clinical pharmacists, including pharmacy residents, seeking to adopt, expand, and sustain CMM services in an ambulatory care setting. Participants are encouraged to attend the 3-day workshop with team members from their practice site (other pharmacists or non-pharmacists) to work collaboratively on the implementation planning.