Coordinated Pharmaceutical Therapy
in Chronic Care:
Five Innovative Programs
Crozer-Keystone Health System,
Delaware County, PA:
As a result of coordinated pharmaceutical services to patients
with complex drug regimens, the health system was able to reduce
instances of polypharmacy for elderly patients during the transition
from inpatient to home care. Home visits allow development of tailored
treatment plans that consider patients' self-care capabilities,
medication regimens, and needs for education. Comprehensive drug
interaction and medication management reviews are conducted. These
results are entered into Crozer's computer system to become part
of the patients' permanent medical records. Through an innovative
partnership with a nearby pharmacy school, services are provided
at no additional cost to the patient. Once the patient has made
a successful transition, pharmacists continue making in-home visits.
Alta Bates Hospital Burn Care Center, San Francisco, CA:
Coordinated care allows the Center to take full advantage of new
advances in burn care for their high-risk, high-cost burn patients
by establishing effective dosage levels for pain control and antibiosis,
managing relationships between pharmacotherapy and diet, and discharge
planning that includes individualized pharmaceutical regimens. The
therapy extends from emergent care to extended care as patients
become accustomed to activities of daily living. An interdisciplinary
team develops and implements coordinated strategies and shares information
at weekly meetings.
Johns Hopkins Bayview Medical Center,
Baltimore, MD:
Through an interdisciplinary care management program for high-risk
patients with coagulation disorders, the Center achieved savings
of 20 percent after one year due to a decreased need for monitoring
and blood tests. A team of physicians, pharmacists and other providers
oversees pharmaceutical treatment for patients and provides education
to patients and other providers and caregivers. The service's longitudinal
database enables continuous monitoring of drug regimens, medical
history and all currently prescribed medications. The program manages
overall costs for patients with atrial fibrillation cardiomyopathy,
congestive heart failure and other conditions requiring anticoagulation
therapy and services.
Palo Alto Foundation Clinic, Palo Alto, CA:
The Clinic was able to maximize coordination of pharmaceutical therapies
by adding a clinical pharmacist, who reports to senior management.
Also, as a result of the Frequent Visitor Program, which identifies
high-risk patients who require additional attention and a high level
of provider coordination, the Clinic anticipates increased medication
compliance, better identification of drug interactions, and active
support of lifestyle habits that compliment drug therapies. The
program also highlights patients who could benefit from further
pharmaceutical coordination efforts, such as patient education,
counseling and compliance support.
San Francisco Department of Public Health, San Francisco, CA:
An innovative partnership between public health officials and not-for
profit programs, the Treatment Education Certification Program has
helped to maximize the value of pharmacotherapy for low-income HIV
positive patients. Non-medical providers, including treatment advocates,
case managers, peer advocates and mental health and substance abuse
counselors, were trained to assist patients in meeting the challenges
of their complex treatments.
The study, "Coordinated Pharmaceutical Therapy in Chronic
Care: Five Innovative Programs," 2000, is available by clicking
here. 
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