Integration of pharmacists into patient-centered medical homes (PCMHs) in federally qualified health centers in Texas



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The Patient-Centered Medical Home (PCMH) model of care is based on coordinated team care that provides personalized and sustainable medical interventions. Meanwhile, the heavy burden imposed by diabetes to the health care system is rising and this burden is even higher among underserved populations. Multidisciplinary team care has been shown to improve diabetes management. However, pharmacists’ involvement in PCMHs varies among settings and few studies have described their integration. This qualitative study describes the pharmacy services integration in PCMHs as adopted by Federally Qualified Health Centers (FQHC) in Austin, Texas. All four clinics in this study have pharmacists who are integrated in the medical team, and who provide pharmacy services according to a collaborative practice agreement. Since early 2013, three of the PCMH group clinics instituted co-visits, where the patient sees both the physician and the pharmacist on the same day. Separate interview sessions were conducted independently with the three PCMH FQHCs and one usual care FQHC to describe the implementation of diabetes-related pharmacy services. A semi-structured interview guide was developed beforehand and the interviews were audio recorded. Qualitative content analysis was conducted, independently, by two researchers to categorize pharmacists’ responses. Discrepancies were resolved through discussions. Clinical pharmacists in the FQHCs work collaboratively with physicians and provide services as guided by the collaborative practice agreement. On co-visit days (PCMH clinics only), the pharmacists may see the patients before or after physician consultation. This co-visit arrangement allows for more collaboration and more efficient communication with physicians. Payment that recognizes value of PCMH is one principle of PCMH that is not fully realized in the study sites. In conclusion, the structure of PCMH and the integration of pharmacy services employed by the FQHCs incorporated the criteria of the Joint Principles of PCMH, namely, personal physician, physician-directed medical practice, whole person orientation, coordinated and/or integrated care, quality and safety, and enhanced access. Effective integration of pharmacist in the PCMH demonstrates that the workflow is established according to the needs of organization and the PCMH caters to alleviate the burden of primary care activities in an underserved patient population.