Pharmacy and COVID-19: Time to Deploy The Most Accessible and Overtrained Healthcare Profession Steven Chen, Pharm.D., FASHP, FCSHP, FNAP Associate Dean for Clinical Affairs William A. Heeres and Josephine A. Heeres Chair in Community Pharmacy University of Southern California School of Pharmacy, chens@usc.edu
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Vital Roles for Pharmacy: • Community containment • Improve chronic disease control 3
“The size of an outbreak can be substantially reduced by quick identification of cases using rapid diagnostic tests.” 4
https://medium.com/@tomaspueyo/coronavirus-the-hammer-and-the-dance-be9337092b56 5
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Pharmacies per 10,000 People by County in the U.S., 2015 In the US: • 67,000 pharmacies, 90%+ of US population lives within 5 miles • 5,500 hospitals • 5,400 emergency rooms • 1,400 community health centers 15,149 https://doi.org/10.1371/journal.pone.0183172 8
Education, quarantine, self-care, referral Immunizations (eventually) Urgent research + • Treatment • Immunity Data tracking Ongoing testing-tracing-quarantine https://www.hhs.gov/sites/default/files/authorizing-licensed-pharmacists-to-order-and-administer-covid-19-tests.pdf?language=es 9
https://medium.com/@tomaspueyo/coronavirus-the-hammer-and-the-dance-be9337092b56 10
“Achieving common acceptance of the need for tens of millions of tests a day and coordinating efforts to hit this target is therefore critical to our ability to go outside again.” “For somewhere in the ballpark of tens to hundreds of billions of dollars, combined with an intelligent use of tracing, we can end a lockdown that is costing the US economy tens of billions of dollars every day.” https://ethics.harvard.edu/covid-19-response 11
• Bluetooth-based • Interoperable between Android and iOS • Preserve privacy https://www.tracetogether.gov.sg/ https://www.apple.com/newsroom/2020/04/apple-and-google-partner-on-covid-19-contact-tracing-technology/ https://www.theatlantic.com/ideas/archive/2020/04/contact-tracing-could-free-america-from-its-quarantine- nightmare/609577/ 12
Vital Roles for Pharmacy: • Community containment • Improve chronic disease control 13
14 http://dx.doi.org/10.15585/mmwr.mm6915e3
Comprehensive Medication Management: Standard of Care for Optimizing Medication Therapy Right choice Comorbidities and other medications PCPCC Resource Guide- Integrating Comprehensive Medication Management to Optimize Patient Outcomes 15 https://www.pcpcc.org/sites/default/files/media/medmanagement.pdf https://innovations.ahrq.gov/qualitytools/patient-centered-medical-home-resource-guide-integrating-comprehensive-medication
• Quadruple Aim aligned • Greater access • Sustainable (value-based payment) https://rightcare.berkeley.edu/wp-content/uploads/2018/05/RCI-Pharmacist-on-Care-Team-Brief- 5.25.18-1PM-FINAL.pdf 16
Pharmacist on the Care Team: Modes of Delivery http://www.pcpcc.net/files/medmanagepub.pdf http://www.cdc.gov/dhdsp/programs/nhdsp_program/docs/pharmacist_guide.pdf
www.calrightmeds.org Mission : To provide optimal medication therapy for high-risk patients in their communities 18
19 IHI Breakthrough Series Collaborative Process Participants: 10-300 teams- Vetted through surveys, Mission : Provide plan data, location, site visits optimal medication therapy for high-risk Prework patients in their communities Dissemination of Results (publication, Congress, etc.) Expert LS2 Leadership LS1 LS3 Holding the Gains AP3 Committee(s) AP1 AP2 Nov ‘18 Sep ‘19 Ongoing Support: • Additional live trainings, including standardized patients • Virtual care training (phone and video telehealth) • Biweekly webinars • Local coaching • Data sharing for quality improvement and aggregation of LS: Learning Session impact measures AP: Action Period 19
USC Clinical Pharmacy Video Telehealth Services • USC Health Sciences Campus • Direct to patient’s home / office • Commercially insured • High-risk heart failure • AltaMed Health Services • To clinic • Medi-Cal population • Common chronic diseases • Several platforms used / available (BlueJeans, WebEx, Zoom, Doxy.me, etc.)
California Right Meds Collaborative: What Makes it Work? Dr. Dri Wang Dr. Ron Victor Dr. Florian Rader Dr. William & Dr. Alex Kang Dr Edward Jai Dr. Mike Blatt Dr. Hanna Sung Psych Sr. MSL Josephine Heeres Dir. Clinical Pharmacy Sr. Director Dir. Clinical Pharmacy Amb Care Pharmacy Director Dr. Jessica Abraham Dr. Jennifer Kwon Jeff Shapiro Vassilios Papadopoulos Dr. Kathy Johnson Dr. Pete Vanderveen Dr. Connie Kang Mariel Romero Dir. Population Health COO Dean CRMC LA Lead QI Coordinator Dr. Rita Shane Sang-Mi Oh Dr. Mike Hochman Dr. Jessica Nunez Dr. Paul Gregerson Hattie Hanley Dennis Wagner Dr. Tony Kuo Noel Barragan Chief Pharmacist VP / Sr. Director Director Chief, Chronic Disease CMO Founder Dir. iQI and Dir. Chronic Disease Program Manager Control Branch Innovation & Injury Prevention Calrightmeds.org 21
California Right Meds Collaborative: What Makes it Work? Stringent pharmacy vetting process USC / Blue Cross / 1000 Schering Community 800 Pharmacy Asthma 600 Program (N=434) 400 200 Clinical documentation 0 platform, CQI Pre Post Calrightmeds.org 22
Rx Rx Rx Rx Rx Rx Rx Rx Rx Rx Rx Rx Rx Rx Rx Rx HEALTH PLANS Rx Rx Rx Rx Rx Rx Rx High Risk Rx Rx Patients Rx Rx Rx Rx Low Rx Rx Rx Rx Rx Risk Rx Rx Rx Rx Rx Rx Rx Rx Rx Rx Rx Rx Rx Rx Rx Rx Rx Rx Rx Rx 23
Pharmacy and COVID-19 • Community containment – “Hammer”: Widespread testing and tracing, reduce pressure on hospitals and ERs, buy time – Facilitate / conduct needed research (eg, treatments, immunity) – “Dance”: Ongoing testing, tracing, quarantine as restrictions lifted • Improved chronic disease control – System struggling to care for patients with other illnesses – Lower risk of severe infection / death – Facilitated by remote care supported by health plans 24
…but only 2,497 locations in the US
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