University of Louisville Physicians: Division of Gastroenterology, Hepatology, and Nutrition

Practice setting

 University of Louisville Physicians: Division of Gastroenterology, Hepatology, and Nutrition. Provides service Friday afternoons and has a patient schedule of 20-30 each week. Clinic is served by GI fellows with an attending present. Pharmacy service includes a preceptor, a PGY2 ambulatory care pharmacy resident, and medication access coordinators. Pharmacy service provides direct patient care for patients with Hepatitis B/C and Crohn’s and Ulcerative Colitis. Additionally, pharmacy helps with medication procurement of specialty medications, medication counseling, and laboratory monitoring.

Why was the pharmacy service developed?

With the increasing opioid/heroin epidemic in the Indiana/Kentucky area, there is an alarming rise in the incidence of Hepatitis C and HIV infections. In Kentucky, the rate of acute hepatitis C increased by 240% from 2009 to 2013.

What training, certification, credentialing, and practice agreement is utilized by the practice site?

Our clinical pharmacist at the gastrointestinal (GI) clinic is a long standing pharmacist that practices in both HIV and Hepatitis C care. No specific credentialing is required for pharmacy involvement in the GI clinic, but a collaborative care agreement is in place. The collaborative care agreement allows for prescribing/adjusting drug therapy and monitoring/ordering laboratory tests for patients with hepatitis C, gastroesophageal reflux disease, Crohn’s disease, and ulcerative colitis.

What outcomes are being measured to evaluate the model's success?

We monitor hepatitis C cure rates and driving specialty medication to our specialty pharmacies. Revenue generate through the clinic is monitored and assessed. Additionally, other interventions are documented and assigned cost avoidance values. 

How have you made this service sustainable?

Driving specialty medications to our outpatient pharmacies pays for the service and partial pharmacist, resident, and medication coordinator FTE. Net profits from the medications filled provide hard dollars for service justification. 

How did you gain support of administrators, providers, and other key stakeholders?

Pharmacy service welcomed to provide expertise on hepatitis C management. Our clinic pharmacist is well versed with the GI fellow program at University of Louisville Physician group and teaches and educates the fellows. 

What are some lessons learned while implementing your practice model that you would like to share?

Specialty medication driving provides a very valuable tool for service justification to administration. Remember to value pharmacy associates (e.g. medication access coordinators), as they can play a significant role in the work flow of the clinic and improve patient satisfaction.