INNOVATIVE PRACTICE FORM

Name: Carey Cotterell

Address: 410 North Lakeview Avenue, Anaheim, CA 92807

Phone #: 714-978-4706

FAX: 714-978-4689

E-mail/Information service: N/A

Briefly describe innovation

Mr. Cotterell is the Director of Pharmacy Services in Orange County, CA, for Kaiser Permanente Medical Care Program. There are approximately one-hundred twenty pharmacists working in ten outpatient pharmacies, one hospital pharmacy, and one home infusion pharmacy. All of the pharmacies are integrated. Also, according to the California Pharmacy Law, the pharmacists in the hospitals and the outpatient setting (if integrated) are allowed to prescribe under a defined protocol if the physician wants him to.

Anticoagulation Service
The pharmacists initiate and manage the drug therapy of approximately one thousand patients who take Coumadin and Heparin for a variety of diagnoses. The pharmacist actually starts the patient on the drug therapy (under protocol). The pharmacist does a patient assessment and orders the appropriate lab tests. He/she then continues to manage the drug therapy and make appropriate changes. There is no need for the patient to even see the physician.

Managing Patients with Hyperlipidemia
Once the patient is determined to need drug therapy, the pharmacist initiates and manages the therapy in concordance with nurse practitioners.
Pharmaceutical Care in the Elderly-an Outcomes Research Project
Approximately five thousand elderly patients over the age of sixty-five are participating in this project. The purpose of the project is to look at the effects of providing pharmaceutical care to the elderly. The project looks at the reduction in hospitalization rates and doctors' visits. The results of this project are being published periodically.

Managing Patients with Asthma
The outpatient pharmacies do not try to manage all asthma patients but it does try to manage the patients who are readmitted continuously or who are noncompliant. The pharmacist can change the drug therapy of the patient, if needed. The pharmacist also tries to educate the patient extensively. If the patient continues to be noncompliant, the pharmacist may choose to use a beeper for the patient. The beeper will beep at the the time of day the patient is suppose to take the medication. It will also have the name of the particular drug the patient needs to take. This beeper has helped with the effectiveness of time sensitive drugs. However, the patient still has to remember to turn the beeper on for it to work.

Pharmacist Refill Authority in the Outpatient Setting
"Therapy Continuation Program"- This is used for maintenance medication which is 80% of the medication filled. The pharmacist, not the physician, is responsible for initiating the refill. The pharmacist also has access to the patient's chart so that he/she can obtain relevant information about the patient's condition. Pharmacist refill authority is primarily done to improve the quality of service for the patient. It does not necessarily cut costs. It is cost neutral. However, it does increase adherence.

Method of Reimbursement

Reimbursement

Reimbursement is not a problem in these pharmacies because Kaiser is under managed care. The patient (insurer) pays a monthly fee. Therefore, there is no fee-for-service.

Documentation

Documentation is not required for the pharmacies to be reimbursed since they are under managed care. However, there is a documentation of services to demonstrate to people higher in the company that the pharmacists are being cost-effective when providing these services.

Specialized training

These innovations do require that the pharmacist complete a clinical pharmacy residency or be able to demonstrate equivalent activities. There is also an internal certification of all pharmacists done once a year.