Exploration of pharmacist integration into a community-based approach for complex vulnerable patients

Exploration of pharmacist integration into a community-based approach for complex vulnerable patients with the Windsor-Essex Compassion Care Community (WECCC)Authors:Doris Nessim, Kathy Pfaff, Michelle Howard, Deborah Sattler, Merrick Zwarenstein, Lisa Dolovich (presenter) BACKGROUND: Globally, health systems are challenged with managing the increasing lifespans and vulnerabilities associated with aging and accompanying chronic diseases, which are often managed with numerous complex medication therapies. The World Health Organization (WHO) recommends integrated person-centered health services (IPCHS) to address health system fragmentation. Compassion care communities (CCC) are an example of IPCHS and are increasing in momentum across Canada.The Windsor-Essex Compassion Care Community (WECCC) is an example of an IPCHS, mobilizing health and social care entities, volunteers, and community agencies in addressing the universal needs of aging, although lacks a focus on medication management for patients with chronic health conditions who are often on several medications.There is an opportunity to optimize the quality of life and care for community-dwelling older adults through exploring the barriers, facilitators and strategies for integrating pharmacists within integrated health care systems such as WECCC. APPROACH: Research Advisory Council (RAC) was created at the start of the research, providing consultation throughout it and consisted of representatives with WECCC, pharmacy, healthcare, and the community.Exploratory qualitative research was conducted. A purposeful sample of 5 participants was recruited consisting of 7 pharmacists in varying practice settings, 3 other healthcare providers (a nurse, nurse practitioner, and WECCC coordinator), 2 community administrators, and 3 WECCC clients. Data were collected using a semi-structured questionnaire and in-depth phone interviews and analysed using inductive thematic analysis of the transcribed data set.Interview questions drew on four scenarios modeled after WECCC clients experiences regarding a: () care transition for an elderly community-dwelling patient; (2) new palliative care diagnosis for an elderly person prescribed new therapy; (3) nurse-referral to a community-based pharmacist for a patient needing chronic pain management; and (4) secluded patient with limited finances to access his prescriptions. RESULTS: Three predominant themes emerged: () comprehension and enacting integrated care (2) effective and timely decision making to medication therapies, and (3) structured and well-functioning healthcare system. The themes are consistent with the WHO IPCHS strategies and align with several of the nine pillars of integrated care of the International Foundation for Integrated Care (IFIC). Participants recognized pharmacists expertise with improving the quality of patient care in each scenario. Barriers, facilitators, and strategies were identified in areas of building relationships, workforce capacity, improving access to resources and digital solutions, care coordination and operational processes, pharmacy curricula and enablers through reimbursement and establishing new alliances such as the concept of a most responsible designated pharmacist role. While clarity to this role evolves, a key component is being a connector to patients between care transitions. IMPLICATIONS: There is an opportunity to optimize the quality of life and care for community-dwelling older adults, and to improve health system-wide structure, processes and governance though integrating pharmacists with the integrated health system and the integrated care team. Further awareness of the IPCHS concepts and integrated care pillars would be helpful across all health disciplines including pharmacists. Pharmacy and community health stakeholders will be engaged in discussions to identify future research opportunities, and practice and policy actions

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