For patients diagnosed with heart failure, getting on the right medications can be a slow process.
At Southfield, Mich.-based Corewell Health, pharmacists are playing a growing role in helping heart failure patients reach guideline-directed medical therapy more quickly. The health system’s “Heart OPtimization and Evaluation,” or HOPE, Clinic, connects pharmacists with patients as often as weekly to adjust medications, address barriers and provide education.
Additionally, the health system’s pharmacist-led goal-directed medical therapy, or GDMT, program focuses on helping heart failure patients reach the highest tolerated doses of guideline-recommended medications as quickly as possible through frequent follow-up, medication titration and patient education.
“We started a quality improvement initiative wanting to get patients on heart failure medications in a timely manner and on their most maximally tolerated dose, if not the maximum dose,” Beth Twydell, PharmD, a clinical pharmacy specialist at Corewell Health, told Becker’s.
The program began within the HOPE Clinic several years ago as a collaboration between cardiology and pharmacy. Today, pharmacists play a central role in managing medication optimization for patients with heart failure with reduced ejection fraction.
Patients typically see a cardiologist, nurse practitioner or physician assistant after diagnosis. Those providers then refer eligible patients to a pharmacist, who follows them through a structured medication optimization process.
For newly diagnosed patients discharged from the hospital, follow-up appointments are generally scheduled within three to five days. Once referred, pharmacists may connect with patients as often as once a week by phone, video visit or in person.
“The goal is to try to get the patients done within those three months from diagnosis,” Ms. Twydell said. “The majority of the patients are done within six months.”
Corewell tracks how many patients are optimized on the four major medication classes recommended for heart failure with reduced ejection fraction. Pharmacists work to help patients reach all four therapies when clinically appropriate while navigating barriers such as cost, side effects and comorbid conditions.
The frequent touchpoints also create opportunities to build trust with patients who may be hesitant about medication changes.
“I do have some patients who will say, ‘I’m not ready yet to make a med change. Call me in a week or two. Let me think about it,'” Ms. Twydell said. “I do a lot of education about why it’s important to try to get on the medications.”
The model relies heavily on collaboration among pharmacists, physicians, nurses, care managers and other members of the care team.
“It is a team effort to really take care of a patient,” Ms. Twydell said. “We have really great cardiologists, our nurses, our MAs, our mid-levels. Everyone works together.”
Unlike some pharmacist-led care models that face organizational resistance, Ms. Twydell said support from physicians and leadership helped the program gain traction.
“Everyone knows the value of getting patients on medications and working all of our staff to the top of their license,” she said.
The experience has reinforced her belief that pharmacists can play a larger role in chronic disease management across healthcare.
Pharmacists’ training, combined with their ability to follow patients more frequently than many physician schedules allow, positions them to help health systems close care gaps, she said.
“We know that getting patients on all four of the medications at their highest tolerated dose as soon as possible does lead to better outcomes,” Ms. Twydell said. “If using a pharmacist or a nurse, I think we’re only going to improve patient outcomes.”
At the Becker's 23rd Annual Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference, taking place June 11-13 in Chicago, spine surgeons, orthopedic leaders and ASC executives will come together to explore minimally invasive techniques, ASC growth strategies and innovations shaping the future of outpatient spine care. Apply for complimentary registration now.
