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florida80 · 05-16-2019

At rural clinic in Oregon, pharmacist restarts widower’s meds under a CPA

Sonya Collins

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“Howard” lost his wife to lung cancer 2 years ago. When he still felt depressed and anxious months after her death, he started antidepressant and antianxiety medications to alleviate his symptoms. Last year, however, Howard and his providers at Monroe Health Center in Monroe, OR, agreed that he was doing better and tapered off his medications.

Then a few months ago, Howard called the health center. He was having suicidal thoughts, depression, and anxiety. He wanted to restart his medications. Monroe Health Center, a federally qualified health center in rural Oregon, 20 miles south of Corvallis, is the only health care available locally to the town’s 500 residents. When the doctor isn’t in—as was the case on the day that Howard called—pharmacists, behaviorists, and other health care team members fill in the gap.

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Adriane Irwin

“If I hadn’t been there,” said Adriane Irwin, MS, PharmD, BCACP, CDE, a clinical assistant professor at Oregon State University College of Pharmacy in Corvallis and a clinical pharmacy specialist at the Monroe Health Center, “there wouldn’t have been anyone in the office to manage that type of problem for about a week.”

Lack of federal recognition

In fact, that would have been the case in most rural outpatient clinics. Pharmacists are not recognized federally by CMS as health care providers, which means few payers reimburse for their services. This distinction sets pharmacists apart from virtually all other health professionals, who can simply bill insurance for the services they provide. Monroe Health Center, a teaching site for student pharmacists at Oregon State University, covers Irwin’s salary with assistance from the university. But not all rural clinics—strapped for cash and personnel—have the support of a nearby university. Without that, a pharmacist is a luxury most rural clinics can’t afford.

“The lack of reimbursement mechanisms is a significant barrier to integration of pharmacists in primary care medical homes,” Irwin said. “If you don’t have a university with a vested interest in the site, it’s very hard to justify a pharmacist in the clinic.”

Collaborative care

Lucky for Howard, the pharmacist was in. After a meeting with the clinic’s behavioral health specialist to ensure he was not suicidal, Howard met with Irwin. With the verbal go-ahead from a doctor in a nearby town, she had the authority to reinitiate his medications under a collaborative practice agreement.

Howard restarted his antidepressant and antianxiety medications that day and came in for a follow-up appointment with the doctor 2 weeks later. “He’s still on those medications, and he’s doing great,” Irwin said.

Rural physician shortages

Howard, like nearly one in four nonolder adults in rural America, has Medicaid. Some 70% of the patients at the Monroe Health Center do. However, Oregon delivers Medicaid through managed care organizations, and many of these organizations do not recognize pharmacists as health care providers. Which is unfortunate, said Irwin, because “using pharmacists as extenders aligns really well with rural areas that are challenged by the number of patients.”

Americans living in rural areas are disproportionately burdened by chronic disease, while they rely on fewer physicians per capita than their urban counterparts for their care. Rural physician shortages show no signs of improving any time soon. “You’re going to continue to have struggles recruiting primary care physicians to these rural areas,” Irwin said. “So why don’t we look for other ways to meet the needs of those patients?”

For Irwin, it’s a question of basic human rights. “It comes down to ensuring equity for all citizens. Everybody has the right to access health care.”

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Provider status stories

Pharmacists are health care providers. In a series of profiles appearing in Pharmacy Today and on pharmacist.com, pharmacists explain how their patients would benefit from provider status. And as part of our campaign for provider status, APhA has asked pharmacists to share their story of how they provide care to their patients and how provider status will improve health care. These stories are collected on the APhA YouTube channel at https://www.youtube.com/user/aphapharmacists/playlists. If you would like to share your story, please visit PharmacistsProvideCa re.com.

05-16-2019	#874
florida80 R11 Độc Cô Cầu Bại Join Date: Aug 2007 Posts: 113,793 Thanks: 7,446 Thanked 47,149 Times in 13,135 Posts Mentioned: 1 Post(s) Tagged: 0 Thread(s) Quoted: 511 Post(s) Rep Power: 161	At rural clinic in Oregon, pharmacist restarts widower’s meds under a CPA Sonya Collins Unlabelled Image “Howard” lost his wife to lung cancer 2 years ago. When he still felt depressed and anxious months after her death, he started antidepressant and antianxiety medications to alleviate his symptoms. Last year, however, Howard and his providers at Monroe Health Center in Monroe, OR, agreed that he was doing better and tapered off his medications. Then a few months ago, Howard called the health center. He was having suicidal thoughts, depression, and anxiety. He wanted to restart his medications. Monroe Health Center, a federally qualified health center in rural Oregon, 20 miles south of Corvallis, is the only health care available locally to the town’s 500 residents. When the doctor isn’t in—as was the case on the day that Howard called—pharmacists, behaviorists, and other health care team members fill in the gap. Unlabelled Image Opens large image Adriane Irwin “If I hadn’t been there,” said Adriane Irwin, MS, PharmD, BCACP, CDE, a clinical assistant professor at Oregon State University College of Pharmacy in Corvallis and a clinical pharmacy specialist at the Monroe Health Center, “there wouldn’t have been anyone in the office to manage that type of problem for about a week.” Lack of federal recognition In fact, that would have been the case in most rural outpatient clinics. Pharmacists are not recognized federally by CMS as health care providers, which means few payers reimburse for their services. This distinction sets pharmacists apart from virtually all other health professionals, who can simply bill insurance for the services they provide. Monroe Health Center, a teaching site for student pharmacists at Oregon State University, covers Irwin’s salary with assistance from the university. But not all rural clinics—strapped for cash and personnel—have the support of a nearby university. Without that, a pharmacist is a luxury most rural clinics can’t afford. “The lack of reimbursement mechanisms is a significant barrier to integration of pharmacists in primary care medical homes,” Irwin said. “If you don’t have a university with a vested interest in the site, it’s very hard to justify a pharmacist in the clinic.” Collaborative care Lucky for Howard, the pharmacist was in. After a meeting with the clinic’s behavioral health specialist to ensure he was not suicidal, Howard met with Irwin. With the verbal go-ahead from a doctor in a nearby town, she had the authority to reinitiate his medications under a collaborative practice agreement. Howard restarted his antidepressant and antianxiety medications that day and came in for a follow-up appointment with the doctor 2 weeks later. “He’s still on those medications, and he’s doing great,” Irwin said. Rural physician shortages Howard, like nearly one in four nonolder adults in rural America, has Medicaid. Some 70% of the patients at the Monroe Health Center do. However, Oregon delivers Medicaid through managed care organizations, and many of these organizations do not recognize pharmacists as health care providers. Which is unfortunate, said Irwin, because “using pharmacists as extenders aligns really well with rural areas that are challenged by the number of patients.” Americans living in rural areas are disproportionately burdened by chronic disease, while they rely on fewer physicians per capita than their urban counterparts for their care. Rural physician shortages show no signs of improving any time soon. “You’re going to continue to have struggles recruiting primary care physicians to these rural areas,” Irwin said. “So why don’t we look for other ways to meet the needs of those patients?” For Irwin, it’s a question of basic human rights. “It comes down to ensuring equity for all citizens. Everybody has the right to access health care.” Unlabelled Box - Provider status stories Pharmacists are health care providers. In a series of profiles appearing in Pharmacy Today and on pharmacist.com, pharmacists explain how their patients would benefit from provider status. And as part of our campaign for provider status, APhA has asked pharmacists to share their story of how they provide care to their patients and how provider status will improve health care. These stories are collected on the APhA YouTube channel at https://www.youtube.com/user/aphapharmacists/playlists. If you would like to share your story, please visit PharmacistsProvideCa re.com.