Care Teams Provide Model for Community Care
by Maura Conry, Pharm.D., M.S.W.
| Geriatric Times |
 |
January/February 2001 |
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Vol. II |
|
Issue 1 |
Pharmacist and social worker care-teams provide community-based support that is
alert and adaptive to the needs of elderly and chronically ill individuals who
live in communities surrounding neighborhood pharmacies. In spite of high
visibility and easy accessibility in most cities, pharmacies are underutilized
as the active community health centers they could be. One innovative care model
creates an interprofessional team of pharmacists and social workers who
collaborate to mobilize communities, families and individuals for the best use
of medical treatments of all kinds.
This team model consists of a pharmacist and a social worker who work out of
neighborhood pharmacies and sometimes even in the homes of high-risk clients
who need regular monitoring and observation to maintain optimal health
outcomes. The model utilizes the strongest attributes of both professions to
address two major causes for concern in these populations: 1) the inability of
many patients to take their medications regularly as prescribed, and 2) the
accidental misuse of prescription medications and non-prescription drugs that
causes dangerous medication misadventures.
Each discipline is particularly effective in a specific professional
activity. Pharmacists' strengths are in clinical, client-centered pharmacy
practice. Social workers' strengths are in effective communication,
problem-solving abilities, human interaction and mobilization of community
resources. Zuckerman (1996) noted, "Twelve percent of the elderly are confined
to home or need help, and 20% to 30% need some kind of in-home services." Risk
factors for these clients include noncompliance, multiple drug use and
inability to swallow.
The patient is the focus of all team efforts. A dynamic triad is formed
between patient, pharmacist and social worker. The patient is always a
functioning member of the team because it is the patient's health and body that
are in question. A care plan consistent with the pharmaceutical-care model of
contemporary pharmacy practice and specific to the needs of the client is
developed. The patient agrees with the plan because the patient has
participated in its development. The team creates medication-management
interventions from two professional perspectives to assist people who must
learn to take lifesaving medications safely and regularly. The care model is
dynamic and interactive, with a heavy social services case-management
component. Slack et al. (1996) indicated, "Pharmacists are in an advantageous
position for providing case management because they frequently practice close
to where people live, they enjoy trusting relationships with patients, and they
are experts in drug therapy."
The program is cost-effective because it utilizes resources that are already
available in most communities and realigns them in a unique way. The concept of
using social workers in pharmacy is not new. In 1991, Kilwein posed the
question, is there a place for social workers in community pharmacy? He
believes there is. Previous attempts to integrate the two professions simply
stationed social workers in pharmacies and did not use them for
medication-management strategies. McCorkle (1997) suggested that social workers
could be used in pharmacies to help indigent patients acquire medications. The
new model is unique in that it uses a pharmacist/social worker care team to
provide a comprehensive pharmaceutical care program with a heavy social
services component.
The thrust of contemporary pharmacy has been, for some time, toward enhanced
pharmacist involvement in the more global psychosocial aspects of patient care.
Lamsam (1997) described a moral dilemma for the pharmacist who must practice
"in the current health care market in which high-volume practice environments
have become standard, the reality of practice is far from the ideal of
pharmaceutical care, and potentially serious drug-related problems go
undetected." The pharmacist is caught between "the patient's interests and the
corporation's demands." Collaboration with the social worker frees the
pharmacist to focus on the clinical aspects of pharmaceutical care, while the
social worker concentrates on the psychosocial issues of adaptation of
lifestyle to medical treatments, consistent with social work practice.
Illness creates problems requiring interventions on physical, psychological
and social levels. Kilwein (1991) stated, "Social workers are trained to view a
patient's problem in its environmental context and therefore are likely to
attempt to resolve that problem from several perspectives, by employing diverse
strategies." Social workers are ideally suited as a psychosocial resource in
community pharmacy; indeed, social work interventions have long been used to
help clients achieve health management goals.
The team social worker always works in very close collaboration with the
clinical pharmacist who provides all direction in medication-management issues.
The pharmacist interacts with the physician in the traditional manner. The
model creates a new professional specialty, the "pharmaceutical social worker,"
who will work in conjunction with a registered pharmacist to provide services
to individuals and communities surrounding the pharmacy.
Both the pharmacist and the social worker collaborate on medication
adherence strategies, polypharmacy management, adaptation of lifestyle to
medical treatment and other issues of medication case management in the home or
in the pharmacy. The pharmaceutical social worker can do home visits, possibly
at the same time the medications are delivered. Complex medication case
management issues can be resolved on an ongoing basis to keep the patient
living in the community as long as possible.
These professionals bring social work skills and values to pharmacy, and
they open pharmacy services to active participation in the community through
social work community interventions. The profession of pharmacy is moving
toward integration of human values into professional curricula. Mrtek and Mrtek
(1991) stated, "[It is] crucial that pharmacy integrate education for human
values, high order thinking, and problem solving skills." Likewise, Bentley and
Reeves (1992) suggested changing social work education to include medication
management, so social workers can better help patients and their families
adhere to recommended therapeutic regimens. The licensed social worker already
possesses case-management and motivational skills that are used in patient
care. The issue becomes how to apply these skills to a wide variety of
techniques to improve patient compliance and widening their applicability to
medication management in the pharmacy setting.
Chronically ill patients or their caregivers have direct contact with
pharmacy personnel on a regular basis when they refill prescriptions. This
gives the team an opportunity to observe changes in the patient's status and
level of functioning, do quick psychosocial evaluations and monitor a number of
high-risk factors. For clients who have their prescriptions delivered,
psychosocial evaluations can be done by the social worker on a monthly basis at
delivery time.
Medication adherence and compliance strategies can be evaluated frequently
by the pharmacist and social worker, who are both knowledgeable of the
individual patient's needs and life goals. Opportunities for improved
monitoring for geriatric clients living at home and in the community have only
just begun to be discovered in this model.
The team model represents a significant contribution to patient care because
it allows major problems in medication management to be addressed from a new
perspective, closer to the patient. Medication problems occur in the home, not
in the doctor's office or pharmacy.
Social workers are also trained to mobilize communities to make the best use
of their neighborhood pharmacy as a center for health services. The social work
practice incorporated into pharmacy allows pharmacy to expand into the
community in a manner new to traditional practice. Social workers can also link
patients with other community resources. Social workers can run community
support groups with the pharmacist for disease-state management and improved
health outcomes. Because social workers are adept at working with divergent
populations, they are uniquely suited to evaluating community demographics and,
with the pharmacist, tailoring programs to specific community needs. Social
workers are already trained to interact with assisted-living and retirement
communities, hospitals, nursing homes, and home health agencies. They function
professionally to keep these systems working collaboratively. Their added value
to pharmacy will enable a single pharmacist to provide enhanced care with a
strong psychosocial and case-management component. Pharmacies can move out of
the dispensing/merchant model of practice and become part of the community
support system in a new way. The result of this professional team model is
pharmacies whose patient populations take and refill their prescriptions
regularly to achieve the best possible health outcomes and remain devoted to
the pharmacy community health center.
Merging the social work and pharmacy professions offers the promise of
improved community health and help to all patients-especially the elderly, the
mentally ill and the disabled-in using their medications safely and regularly.
Both professions work collaboratively using their skill sets. Pharmacy will
benefit from the integration of the practice strategies of the client-centered
interventions of social work and their application to medication adherence and
compliance. Pharmacy can begin to form new permanent connections to the aging
population and the chronically ill in the communities that surround them. The
two professions will learn much from each other's practice skills. The
literature of pharmacy strongly suggests the need for an alliance with other
professions to improve patient compliance. Health care is moving toward
improved patient care utilizing integrated delivery systems built by teams that
make use of professionals from all disciplines. Pharmacy can only benefit from
a strong alignment with a profession that has high visibility and a long
history of client-centered service.
Dr. Conry is both a clinical pharmacist and a clinical
social worker practicing in the greater Kansas City area. She is believed to be
the only person in the United States who holds both a master's degree in social
work and a doctorate in pharmacy.
References
Bentley KJ, Reeves J (1992), Integrating psychopharmacology into social work
curriculum: suggested content and resources. Journal of Teaching in Social Work
6(2):41-58.
Kilwein JH (1991), Social workers in the community pharmacy: why not? Am
Pharm NS31(7):60-61.
Lamsam GD (1997), Human dignity and pharmaceutical care. Am J Health Syst
Pharm 54(23):2733-2735.
Mrtek RG, Mrtek MB (1991), Parsing the paradigms: the case for human values
in the pharmacy curriculum. Presented at the 91st American Association of
Colleges of Pharmacy Annual meeting. July 10; Salt Lake City.
McCorkle K (1997), Pharmaceutical assistance programs: a social worker's
guide. Newsletter of the Council of Nephrology Social Workers 23(2):15.
Slack MK, McEwen MM, Carter JT, Brueckner RL (1996), Case management
delivery model for pharmacy. Am J Health Syst Pharm 53(23):2860-2867.
Zuckerman IH (1996), Providing care to homebound patients. U.S. Pharmacist
Supplement. April:3-7.