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Implementing Programs to Improve the Care of South Dakotans with Diabetes, Heart Disease, and Stroke through CDC-1815: Year Three

Year 3

Investigators from the College of Pharmacy and Allied Health Professions at SDSU are engaged in a five-year project, prompted by a call-to-action from the CDC to develop solutions to improve the care of South Dakotans with diabetes, heart disease, and stroke.

During the first year, the project team, led by Dr. Sharrel Pinto, interviewed South Dakota patients, practitioners, and payers and found that more information on the role of the pharmacist and the positive effect of pharmacist services like medication therapy management (MTM) is needed. In Year Two, the project team expanded as they made strategic plans to recruit more participants and begin development on educational materials.

Continuing to work in the three distinct workgroups, the project team set out to implement a variety of educational materials developed over the first two years. This included the launch of the Your Pharmacist Knows Campaign, presenting four webinars and five posters, and continuing development on several papers.

The patient workgroup’s primary goal for Year Three was to launch the Your Pharmacist Knows campaign and continue recruitment and enrollment.

Major needs identified in Year One, actions taken to address needs in Year Two, and programs implemented in Year Three
Year One: Identified Needs Year Two: Addressing Needs Year Three: Implementing Programs
Non-pharmacist practitioners needed more education on pharmacist expertise and services Focused educational efforts, such as a development of a webinar, geared toward educating non-pharmacist practitioners on pharmacist background, expertise. and services for patients Continued engagement with non-pharmacist practitioners at collaborating sites: Incorporated MTM information into an EHR for provider use and patient education
Pharmacists expressed a desire to be a more integral part of the healthcare team In-depth conversations and strategies with partners to empower pharmacists and their administrators to integrate them into the patient healthcare journeys Pharmacists integrated into new healthcare teams including two clinics and a team serving Medicaid patients
Pharmacists needed guidance on integrating MTM services into workflow Development of a webinar on MTM and its practical applications; Advanced training for 27 SD pharmacists, including actions. templates, and workflow processes to help implement MTM immediately in their practice Specialized workflow guidance for each collaborating site; shared successful practices within and across collaborating sites
Patients needed more understanding of services pharmacists provide Development of a thorough patient awareness campaign that will help patients begin to familiarize themselves with these Distribute campaign materials at pharmacies across the state; Launch of "Your Pharmacist Knows" ad campaign; website tracking enabled
Payers understood team-based care but needed help in figuring out how to reimburse pharmacists for their services Development of a toolkit that will provide detailed instructions, examples, and forms for payers to customize for their needs in reimbursing for pharmacy-based services Finalized toolkit; received recommendations and suggestions for further customization of the toolkit based on site/setting; additional material will be added to the toolkit as needs are identified

The Your Pharmacist Knows Campaign launched in September of 2020 with the release of a 30-second television commercial. The commercial ran on air from September to December in 2020, then again for five weeks beginning in April 2021.

The team also developed newspaper ads, business cards, and brochures, each of which included links to the campaign website: www.sdstate.edu/your-pharmacist-knows. The newspaper ads ran in 116 newspapers across South Dakota for six weeks beginning in March 2021. The team examined website traffic to find that over the course of the campaign, “340,000 impressions were made to South Dakotans.”

The patient workgroup also worked together with the practitioner workgroup to continue recruiting for the project. Surveys were conducted to assess the effectiveness of the campaign.

In addition to assisting the patient workgroup, the practitioner workgroup’s primary goals for Year Three were to continue collaborating with Integrated Delivery Networks (IDN) and Independent Community Pharmacies (ICP) to expand and improve MTM implementation and provide American Public Health Association (APhA) trainings.

Over the course of Year Three, the practitioner workgroup provided APhA training for 30 pharmacists. Of these, 21 completed MTM training, 4 completed cardiovascular disease training, and 5 completed diabetes training. 

The practitioner workgroup also continued positive and productive relationships with two collaborating IDNs, allowing them to reach even more patients in Year Three by expanding to three new sites. One of these collaborators provided MTM services to 3053 patients, focusing in particular on adherence needs and disease state education. The other provided MTM services to 1835 patients, with focuses on medication dose changes, patient education, and helping patients start new medications.

Additionally, the team began working with three new collaborators to establish MTM services. Most of the Year Three work with these collaborators was spent on onboarding processes in order to best set up the new sites to provide MTM services, including developing “MTM workflows, enrollment criteria and generation of patient lists, documentation and referral processes, reports, and pharmacist education,” as well as the integration of a pharmacist at one of the sites. 

To assess and monitor effectiveness, the practitioner workgroup determined that “evaluation of economic, humanistic, and clinical outcomes will be done by collecting surveys every six months,” in addition to pharmacist tracking and claims data. Such data will be evaluated in Year Four.

Meanwhile, the payer workgroup’s primary goals for Year Three were to release the Payer Toolkit and maintain positive relationships with collaborating payers.

The Payer Toolkit, developed in Year Two, is to be “used by payers and practitioners to clarify reimbursement options and other regulations and requirements for implementation.” In Year Three, this toolkit was finalized, though the project team clarified that “updates will continue to be made as needs arise.”

The payer workgroup also conducted elicitation interviews with five leaders from collaborating payers and major themes from these interviews were recorded in a brief. Through such practices, the team continued to foster positive relationships with payers.

In some cases, however, payers serving Medicaid patients were hesitant to assist the project team by releasing data which would have allowed the project team to assess the economic impact of MTM services. The project team developed an alternative solution, however, and positive relationships were maintained.

Additionally, in Year Two, the project team set out to work directly with tribal nations and organizations that serve the American Indian population of South Dakota. In Year Three, while strains from the pandemic impacted some communications, the team successfully formed a partnership with a Federally Qualified Health Center (FQHC) that serves urban Indian populations in South Dakota.

Year Three saw continued development of the work begun in Year One and continued in Year Two. Where Year One was spent identifying major needs surrounding pharmacy and MTM services in South Dakota, and Year Two was spent strategizing ways to address those needs, Year Three focused on implementing some of those strategies. In Year Four, the project team plans to “continue expansion of services at partnering sites, collaborating on data collection and evaluation, and development of patient education materials.”

Sources:

https://doh.sd.gov/documents/diseases/chronic/MTM_Year3_AnnualReport.pdf

https://doh.sd.gov/documents/diseases/chronic/MTM_Year2_FinalReport.pdf