1 Department of Pharmacy Practice, Nova Southeastern University College of Pharmacy, Palm Beach Gardens, Florida.
J Manag Care Spec Pharm. 2017 May;23(5):541-548. doi: 10.18553/jmcp.2017.23.5.541.
The accountable care organization (ACO) is an innovative health care delivery model centered on value-based care. ACOs consisting of primary care providers are increasingly becoming commonplace in practice; however, medication management remains suboptimal.
As experts in medication management, pharmacists perform direct patient care and assist in the transition from one provider to another, which places them in an ideal position to manage multiple aspects of patient care. Pharmacist-provided care has been shown to reduce drug expenditures, hospital readmissions, length of stay, and emergency department visits. Although pharmacists have become key team members of interdisciplinary teams within traditional care settings, their role has often been overlooked in the primary care-based ACO. In 2015, Nova Southeastern University College of Pharmacy founded the Accountable Care Organization Research Network, Services, and Education (ACORN SEED), a team of pharmacy practice faculty dedicated to using innovative approaches to patient care, while providing unique learning experiences for pharmacy students by partnering with ACOs in the South Florida region. Five opportunities are presented for pharmacists to improve medication use specifically in primary care-based ACOs: medication therapy management, annual wellness visits, chronic disease state management, chronic care management, and transitions of care.
Several challenges and barriers that prevent the full integration of pharmacists into primary care-based ACOs include lack of awareness of pharmacist roles in primary care; complex laws and regulations surrounding clinical protocols, such as collaborative practice agreements; provider status that allows compensation for pharmacist services; and limited access to medical records. By understanding and maximizing the role of pharmacists, several opportunities exist to better manage the medication-use process in value-based care settings.
IMPLICATIONS/RECOMMENDATIONS: As more organizations realize benefits and overcome barriers to the integration of pharmacists into patient care, programs involve pharmacists will become an increasingly common approach to improve outcomes and reduce the total cost of care and will improve the financial viability of primary care-based ACOs.
No outside funding supported this research. The authors report no conflicts of interest related to this manuscript. Study concept and design were contributed by Joseph, Hale, and Eltaki, with assistance from the other authors. Prados and Jones took the lead in data collection and data interpretation and analysis, with assistance from the other authors. The manuscript was written primarily by Joseph and Hale, along with the other authors, and revised primarily by Seamon and Gernant, along with the other authors.
责任医疗组织（ACO）是以基于价值的医疗为中心的创新医疗服务模式。由初级保健提供者组成的 ACO 在实践中越来越普遍；然而，药物管理仍然不尽如人意。
作为药物管理方面的专家，药剂师进行直接的患者护理，并协助从一位提供者过渡到另一位提供者，这使他们处于管理患者护理各个方面的理想位置。已证明药剂师提供的护理可以降低药物支出、医院再入院率、住院时间和急诊就诊次数。尽管药剂师已成为传统医疗环境中跨学科团队的关键成员，但他们在以初级保健为基础的 ACO 中的角色经常被忽视。2015 年，东南大学药学院成立了责任医疗组织研究网络、服务和教育（ACORN SEED），这是一个由药学实践教师组成的团队，致力于通过创新的方法提供患者护理，同时通过与南佛罗里达州的 ACO 合作，为药学学生提供独特的学习体验。提出了五种机会，以改善药物使用，特别是在以初级保健为基础的 ACO 中：药物治疗管理、年度健康访视、慢性病管理、慢性病管理和护理交接。
一些阻碍药剂师全面融入以初级保健为基础的 ACO 的挑战和障碍包括对药剂师在初级保健中的作用缺乏认识；临床协议（如合作实践协议）的复杂法律和法规；允许对药剂师服务进行补偿的提供者地位；以及对医疗记录的有限访问。通过了解和最大化药剂师的作用，可以为更好地管理基于价值的医疗环境中的药物使用过程创造更多机会。
影响/建议：随着越来越多的组织意识到将药剂师纳入患者护理的益处并克服整合的障碍，涉及药剂师的计划将成为改善结果和降低总医疗成本的一种越来越常见的方法，并将提高以初级保健为基础的 ACO 的财务可行性。
本研究没有外部资金支持。作者报告与本手稿无关的利益冲突。Joseph、Hale 和 Eltaki 为研究概念和设计做出了贡献，其他作者也提供了帮助。Prados 和 Jones 带头进行数据收集和数据解释与分析，其他作者也提供了帮助。手稿主要由 Joseph 和 Hale 与其他作者共同撰写，并由 Seamon 和 Gernant 与其他作者共同修订。
