Advancing Pharmacy Practice through the Implementation of a Heart Failure Medication Management Clinic
Maria M. Claudio, Pharm.D., BCPS, Qazi Halim, B.S., M.S., Linda Yee, Pharm.D., Saumya Mathew, Pharm.D., Elizabeth Watson, Pharm.D., BCPS, Wayne Gietz, M.A., Ankhnu Uaskhem, M.D.
Brookdale Hospital Medical Center, Brooklyn, New York
Brookdale Hospital Medical Center provides care to an underserved and impoverished community. In 2010, the 30-day readmission rate for Heart Failure (HF) in this institution was 29.4% which was greater than the national average of 24.8%. Hospital administration envisioned a pharmacist-led Heart Failure Medication Management Clinic (HFMMC) as one approach to improve the transition of care for these patients to the outpatient setting. The goal of this clinic was to reduce the 30-day readmission rate for HF by optimizing medication regimens, improving patient compliance, and individualizing medication and nutrition education.
The HFMMC is staffed by a multidisciplinary team consisting of physicians, pharmacists, nurses, and a nutritionist. Initially the HFMMC met once a week for four hours. In the inpatient setting, eligible patients are identified for the HFMMC through admitting diagnosis codes. Pharmacists provide discharge medication counseling and a clinic appointment is scheduled. The nurses also assist in recruiting patients and scheduling clinic appointments. In the outpatient setting the nurse monitors the patient’s weight and vital signs. Pharmacists conduct medication reconciliation, provide medication counseling, identify and address barriers to medication adherence, review and order pertinent blood tests, and recommend necessary medication adjustments in accordance with HF guidelines. Each patient is examined by the physician. The nutritionist is consulted if necessary. The pharmacist and attending physician collaborate on final medication regimens and discuss the treatment plan with the patient. Patients are followed up in subsequent visits as determined by their treatment plan. Empowering patients to be active partners in their disease management is a vital component of the HFMMC.
The HF program began on October 28, 2010. Data analysis was performed from January 1 to December 31, 2011. A total of 68 patients were followed during the data collection time period. The 30-day hospital readmission rate for HF exacerbation for patients followed in the clinic was less than 3%. Documented pharmacists’ clinical interventions include: dosage changes (24%), initiation of therapy (17%), discontinuation of therapy (10%), identification of adverse drug events (3%), and other (47%).
This clinic model is innovative in that it focuses on medication management and identification of barriers to therapy compliance thus empowering patients to be active participants in their own care. This model is readily adaptable to other patient populations with high re-admission rates.
View a pdf of the poster from the Midyear Meeting (203 KB)