Restoring the joy: CMM and primary care

Blog | Restoring the joy: CMM and primary care

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By Paul Grundy, MD, MPH, GTMRx Institute Founding Board Member

July 26, 2019

Engaging physicians and other team members to optimize medication use through comprehensive medication management (CMM) mitigates burnout for primary care providers (PCPs). That’s no surprise to me or to my colleagues who share a complete commitment to team-based primary care.

What we’ve long known has been documented in a new peer-reviewed paper, “Primary Care Providers Believe That Comprehensive Medication Management Improves Their Work-Life,” (Funk KA, et al. J Am Board Fam Med. 2019 Jul-Aug). This is an important evaluation designed to specifically examine the impact of CMM on PCPs’ professional wellbeing–in particular, burnout.

The opportunity of CMM to optimize medication use has been well established; now we have a study that points to evidence that it enhances the provider experience as well.

This study pulls a lot of pieces together:

• Having a pharmacist on the care team makes the provider more efficient and effective around medication use.
• CMM improves outcomes for patients and decreases costs.
• Team-based approaches improve engagement and decrease burnout for health care providers.

This paper specifically ties decreased burnout and improved joy in practicing medicine to embedding a clinical pharmacist in the primary care team. I want to focus on a few themes that I found especially promising.

Collaborative partnerships: The ability to work closely with another professional to care for patients and discuss care plans made PCPs feel more supported, reassured and less burned-out.

Message reinforcement: By reinforcing treatment decisions, clinical pharmacists increased the likelihood of the patient agreeing with and accepting those decision, lifting a burden off the PCPs’ shoulders.

Burden sharing: It’s especially telling how much the PCPs interviewed spoke of sharing the care of some of their patients. It supports collaboration, frees up more time for the PCP, increases satisfaction and reduces mental exhaustion. One aspect that jumped out at me was the pharmacist’s ability to navigate the insurance system. This alone is a tremendous boon for the PCP.

Better care, more meaning: The positive responses from PCPs were not merely related to being freed up from certain tasks around medication management. The PCPs were heartened by the improved care their patients were receiving; the collaboration contributed to their sense of meaning in work.

More efficient use of time: Many PCPs reported that their visits with patients were more efficient after being seen by a pharmacist providing CMM; the providers could direct their attention to medical concerns rather than medication-related problems. Interviewees spoke of the utility and value of having the pharmacist available as a resource. I believe, in large part, this is because everyone is working in their fields of expertise, and at the top of their licenses.

Understanding CMM

This study is also significant in another way: It provides further clarification of the steps involved in a systematic approach to medication use. CMM is a team-based, patient-centered activity that improves patient care and access by utilizing the skills of allclinicians on the care team.

By reinforcing the value of team-based care, and offering an important value-added service designed to optimize medication use, we build on work we began at the Patient-Centered Primary Care Collaborative.

We know getting the medications right will allow us to change the quality of health care. We’re going down a road where if there’s no outcome, there’s no income. The easiest way to improve outcomes is to get the medications right. And, it turns out, it’s also an excellent way to restore the joy of practice.

As we transform our health care system away from volume and toward value, CMM will be essential.

A personalized, patient-centered system and a coordinated approach to medication use will dramatically improve outcomes, reduce overall costs and improve people’s lives. We knew this more than a decade ago with the launch of the Patient-Centered Primary Care Collaborative (PCPCC). We knew it when the PCPCC first published Integrating Comprehensive Medication Management to Optimize Patient Outcomes (revised in 2012). And we knew it this year when we launched the GTMRx Institute.

CMM will become more essential as we continue the trek toward value-based, advanced primary care. We will get the medications right. Join us on this journey the become part of the work of the GTMRx Institute today.