Duke University Health Systems
The Duke Pharmacy Technician Home Visit Program was implemented in March 2017, as part of the global aim of the Duke Population Health Management Office (PHMO) to improve quality of care and overall health care cost for patients eligible for DukeWELL population health care management services. Eligibility is determined by patients being attributed to the Duke Connected Care accountable care organization (ACO) or having insurance with another payer that has a value-based contract managed by the Duke PHMO. Patients living in specific zip codes in the Raleigh-Durham region of North Carolina are identified as possibly benefiting from a home visit. Care management, providers, and various reports have been utilized to identify eligible patients.
Why was the pharmacy service developed? (Describe any compelling data collected prior to implementation)
The Duke PHMO was already conducting nurse home visits but realized that more patients could be reached by developing a pharmacy technician home visit program. A pharmacy technician home visit allows for greater understanding of how a patient is managing their medications and also obtain screening information related to medication adherence barriers and social determinants of health. Pharmacy technician visits are made independent of nursing staff, with a focus on obtaining an accurate medication history and evaluating patients for additional needed resources such as transportation, food insecurities, hazardous living conditions, etc. Several studies have been published outlining the role of pharmacy technician in a transitions of care program. Published data include identifying drug related problems, difficulty paying for medications, and lack of transportation.
What training, certification, credentialing, and practice agreement is utilized by the practice setting pharmacist(s)?
One certified pharmacy technician is utilized throughout the program to conduct home visits two days per week. The technician was trained on obtaining a medication history, completing a needs screening, navigating and documenting in the electronic medical record, and on safety provisions for conducting home visits.
What outcomes are being measured to evaluate the model's success? (Clinical metrics, revenue, cost-savings, patient satisfaction, etc.)
- Number and types of medication discrepancies, number and types of interventions completed
- Appointment no show rate
- Patient satisfaction survey results
- Community resource and care management referrals
How have you made this service sustainable? (Include billing, reimbursement, etc.)
The funding for this service is provided by the Duke PHMO as an integrated service with DukeWELL care management services. These services are provided free of charge as part of the Duke Health’s population health services.
How did you gain support of administrators, providers, and other key stakeholders to implement your practice model?
Since pharmacy services were already integrated into the Duke PHMO, a key to gaining support was to collectively make the decision to develop and implement these services through discussions with PHMO administrative, medical, and care management leadership.
What are some lessons learned while implementing your practice model that you would like to share with other pharmacists?
Similar to any other new service, it is important to have a plan to proactively identify and recruit patients that may benefit from the service. Additionally, conducting home visits requires coordination to efficiently and effectively serve as many patients as possible. Having a skilled pharmacy technician and thorough training were also key to successful implementation.