Active Monitoring and Formal Care Planning Distinguish Enhanced Care from Usual Care
2023-11-28In a previous post, I described a model of escalating patients to "Enhanced Care" to help resolve drug therapy problems using a more formalized pharmaceutical care process.
A key question that follows: What are the characteristics of "usual/routine care"?
During routine dispensing in a community pharmacy, there is seldom time or workflow affordances to conduct continuous, comprehensive medication management. Rather, care often looks like receiving prescriptions from physicians, NPs and other providers, counselling patients about safe and effective use of medications and conditions, and screening for potential problems with drug therapy that may requires further assessment or intervention.
Once a potential drug therapy problem is identified, it can be managed in a couple of ways:
- Dismissed as not-clinically-relevant
- Resolved informally through brief discussion with the patient or prescriber.
- Through the delivery of a targeted non-dispensing service to resolve the issue (e.g. adapt the dose)
- Through engaging the patient in more complex and generalized care planning services (e.g. advanced medication review, chronic disease management, Bloom)
Enhanced Care is care involving the maintenance of a formal care plan that is explicitly documented and evolves over the course of several patient encounters as part of an active monitoring plan. It would be initiated though AMR, CDM, or similar as the "initial assessment" from which the followup evaluations would be based on.
All patients may not require this degree of formalized pharmacy-led care, and patients enrolled Enhanced Care may be discharged back to usual care once drug therapy problems are resolved and the patient's health status is well-enough controlled. For patients that have a family practice, they would continue receiving continuous, comprehensive medication management services from their primary care practitioner.
Further expansion of this idea could explore what patients may be good candidates for Enhanced Care services, how to optimize transitions in care (detection, enrolment, and discharge), and how to manage patients who are "unattached" (those without a family practice and therefore have no most-responsible provider providing primary care services on an ongoing basis).