A pharmacy's journey toward the patient-centered medical home

To describe the integration of a clinic pharmacy with a patient-centered medical home (PCMH).

Primary care clinic in Monroe, WA, from 1981 to January 2011.

Pharmacists and physicians with a previous working relationship in a family practice residency program established colocated practices in 1981. In addition to traditional pharmacy services, collaborative practice agreements were developed and clinical pharmacy services expanded over time. Reimbursement challenges for clinical pharmacy services existed in the fee-for-service environment. The acquisition of the clinic and pharmacy by Providence Health and Services created a new financial alignment with additional opportunities for collaboration.

An internally funded grant established a PCMH pilot that included pharmacist participation. PCMH pharmacists and the care provider team identified areas to improve physician and clinic efficiencies and to enhance patient care.

Clinical pharmacy services expanded under the PCMH model. Pharmacist activities included value-added refill authorization services, coordinated patient visits with the PCMH pharmacist and physicians, medication therapy management, diabetes and anticoagulation services, hospital discharge medication reconciliation, and participation in the shared medical appointment.

Clinical pharmacy services are woven into the PCMH fabric of this clinic. New pharmacists will be challenged and rewarded in this evolving health care model.