The State of Maryland allows pharmacists to practice under collaborative drug therapy management agreements. New regulations were approved in 2012 and implemented in 2013.
Dr. DiPaula has practiced collaboratively at People’s Community Health Center and currently practices at the Howard County Health Department. Below is a description of these practice sites.
Howard County Health Department
This suburban Health Department (HD) is the only publicly funded prevention and integrated treatment (substance abuse and mental health) program in the county. The HD provides psychiatric and substance abuse care 5 days per week. A physician-pharmacist Suboxone maintenance clinic was piloted in 2012. The HD had previously referred the Suboxone patients to community physicians at considerable cost with varying outcomes. A psychiatric pharmacist and primary care physician partnered to create an internal clinic, which included the development of a treatment contract, policies, and protocols. The goals were to optimize care, reduce cost, and limit diversion. The pharmacist’s unique training allowed the physician to manage the patient load during just a few hours per week. All intake assessments and follow up appointments were conducted by the pharmacist. After each appointment, the pharmacist would debrief the physician, allowing for efficient completion of the assessment by the physician. The pharmacist documented each interaction. The physician appended notes, when applicable, and cosigned. The pharmacist and physician electronically accessed substance abuse counselors’ treatment records. Counselors and providers met directly to review treatment plans and outcomes. The pharmacist worked to limit diversion by routinely gathering data from outside providers, pharmacies, and laboratories. Findings from a short-term assessment demonstrated improved patient care through consistency and structure as well as cost savings by preventing community referrals. Dr. DiPaula received State approval for her collaborative practice protocol. Most recently, a collaborative Suboxone group was started.
People’s Community Health Center
People’s Community Health Center (PCHC) is a federally qualified health center with clinics and physician practices in high poverty areas. It has evolved to become a full service medical, dental, and behavioral health center accredited by the Joint Commission. Dr. DiPaula worked collaboratively with physicians at PCHC from 2005 to 2012. She offered drug therapy management for both psychiatric and Suboxone-maintained patients.
- From July of 2009 to December 2010, a board-certified psychiatric pharmacist and three PGY-2 residents provided medication management services for 67 unique patients over 191 appointments.
- Sixty percent of the patients had at least one co-morbid psychiatric diagnosis.
- A total of 634 interventions were made. The most common interventions included assistance in refilling buprenorphine prescriptions, ordering toxicology screens, and educating patients.
- The pharmacist made an average of 3.3 types of interventions per patient.
- Patient encounter sheets were completed for tracking and billing purposes. While the facility did not routinely bill, it was reimbursed $130 per patient visit using the 99211 code when they did. The projected potential revenue generated by pharmacist visits was $24,830.