The design and evaluation of a pilot covisit model: Integration of a pharmacist into a primary care team

To describe the integration and evaluation of a pharmacist into a primary care team utilizing a pilot covisit model to improve and expand care.

An urban satellite practice of a multisite, urban federally qualified health center.

Cincinnati Health Department is a large, multisite, federally qualified health center (FQHC) serving residents of southwest Ohio. This study took place at one satellite clinic-Millvale Health Center.

Redesigning the primary care team by integrating a pharmacist 1 day per week utilizing a covisit model. This was done to improve workflow in the management of patients with uncontrolled chronic disease, focusing on those with diabetes.

Changes in clinical outcomes of patients with diabetes using glycosylated hemoglobin (A1C) and systolic and diastolic blood pressures were compared with productivity information from covisits conducted between February 1, 2018, and May 30, 2019, using defined time frames.

Improvement in A1C of 0.46% (n = 55, P = 0.059) and both systolic and diastolic blood pressure by 1.18/2.56 mmHg (n = 82, P = 0.459, P = 0.023, respectively) were seen in patients within the covisit model from baseline to final. Reductions in these markers were not correlated with the number of visits within the pilot model (A1C r_s = 0.237, systolic blood pressure r_s = 0.090, diastolic blood pressure r_s = 0.115). A total of 95 patients with diabetes were seen at 147 covisit appointments; each patient had an average of 1.77 appointments within the model (range, 1-6). The most frequently discussed disease states included diabetes and hypertension, and visits were frequently 30 minutes or longer in duration.

Integrating a pharmacist into a primary care team within a FQHC offers potential improvements in both productivity as well as chronic disease state markers.