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McBane finds her medical home
L. Michael Posey, BPharm
American Pharmacists Association
Collaborative care a key part of vision for reformed health care system.
Medical homes—you’ve read about them in the New York Times, heard them mentioned on CNN, and learned that they are included in health care reform legislation making its way through the Senate and House of Representatives. But how would a pharmacist fit into a medical home anyway?
A good place to get that answer is from North Carolina’s Sarah McBane, PharmD, BCPS, CDE, CPP, who splits her time between a patient-centered, level 3, certified medical home at Duke University Medical Center and teaching pharmacy practice to students at Campbell University School of Pharmacy. In an interview with pharmacist.com, McBane said that her medical home site is very much collaborative: She spends 80% of her time in a Duke family medicine clinic with physicians, nurse practitioners, and physician assistants helping to improve medication use and advance patient care. “On Monday and Thursday mornings, I am in clinic, providing general pharmacotherapy services,” McBane explained. “I might be meeting with patients who have asthma or diabetes, counseling patients on smoking cessation, or reviewing complicated medication regimens. Even though I meet with patients one on one, the care is coordinated with all my colleagues in the medical home.”
On Tuesday and Wednesday McBane and a physician assistant provide anticoagulation services at Duke Family Medicine. McBane teaches collaborative care to student pharmacists, physicians, and physician assistants on rotation at Duke during clinic sessions. For the other 20% of her week, she is involved in clinical improvement committees, research, and didactic teaching, and sometimes drives the 50 miles to Campbell University for lectures.
An excellent description of the medical home was in the New York Times article, which focused on the care of one of McBane’s patients, a 57-year-old man with congestive heart failure, diabetes, kidney failure, high blood pressure, gout, high cholesterol and blindness in one eye. If rolled out nationally as part of health care reform, the medical home will have to be “thought of not as a place like the clinic where I practice, but as a way that physically dispersed providers can work closely in caring for the patient,” said McBane. “Through better electronic medical records and e-prescribing, and in places such as small towns where the physicians, pharmacists, and patients all know each other, the model could work really well.”
If McBane has a concern about the medical home model, it relates to reimbursement. “One of my hopes for health care reform ,” noted McBane. “is that pharmacists can get better reimbursement not just for products but for our cognitive services. If the physician is not required to spend as much time with patients because of the pharmacist’s services, then I hope that economy will be built into the reimbursement schedules for medication therapy management.”
Related resources on www.pharmacist.com
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