Provider Status Profile
Sonya Collins
Patient “Matt” came into Brewster Family Pharmacy in rural Brewster, OH, to pick up his prescriptions. Chip Cather, PharmD, had synced them so that Matt could pick everything up on the same day every month. While the patient was there, Cather mentioned to him that his insurance would cover a consultation to sit down and go over all his medications. At just 38 years old, Matt was overweight, a smoker, and living with type 2 diabetes and hypertension.
“It was supposed to be a brief appointment to go over his medications,” Cather said, “but the next thing you know, he’s brought out three or four problems that he’s been having.”
Brewster Family Pharmacy is part of a Medicaid/United Health Care Managed Care Organization pilot. Through the program, Medicaid reimburses pharmacists to provide medication therapy management, disease state management, and any other interventions within their scope of practice that could promote the health of their beneficiaries. Outside of such a program, health insurance typically doesn’t reimburse pharmacists for patient care services. The Centers for Medicare and Medicaid Services, which sets the standard for the benefits health plans cover, does not recognize pharmacists as health care providers. However, pilot programs like this one demonstrate the value that pharmacists add to patient care.
“We are in a rural area, with an aging population, a large Medicaid and Medicare population, and getting to a doctor’s appointment isn’t always easy,” Cather says. He cites lack of transportation and distance to the nearest medical practices among the many barriers to care that rural Americans face.
After Cather reviewed Matt’s medications, he asked whether there was anything else Matt would like to discuss. Matt mentioned swelling in his legs, migraine headaches, eye pain and seeing spots, and a recent ER visit for urgently high blood pressure. But Matt hadn’t discussed any of these issues with his primary doctor. He said his next appointment was still weeks away.
“It sounded like he would have just let these issues go until he could get to the doctor if it hadn’t been for the appointment at the pharmacy,” Cather said.
Cather suggested that Matt’s blood pressure medications might be causing the leg swelling. Given the recent ER visit, it appeared that the medication wasn’t working well for Matt anyway.
“His blood pressure was very high, which also could have caused the eye pain and the migraines,” Cather said. The pharmacist set the patient up with a blood pressure monitor and contacted the doctor’s office to let them know about the problems Matt had been having.
“Lo and behold, they got him in for an appointment that week,” Cather says.
The doctor switched Matt’s blood pressure medication. His blood pressure fell to within a normal range and the swelling stopped. In regular follow-ups with the patient, Cather continued to monitor his blood pressure and blood sugar. Cather faxes Matt’s blood sugar logs to the doctor, as well.
Cather hoped that by getting Matt’s blood pressure under control, the headaches, eye pain and spots would dissipate, but they haven’t. The pharmacist is now working to connect the patient with an ophthalmologist.
“It’s not a blood pressure problem now,” Cather says. “It’s an eye problem, and when you’re diabetic, it’s very important to get that checked out.”
Throughout the course of taking care of Matt’s blood pressure and the side effects of his medication, Cather has cultivated a trusting relationship with the patient. The pharmacist is now laying the foundation to work with Matt on smoking cessation and better nutrition.
By closing the gap between rural Ohioans and primary care, Brewster Family Pharmacy may be helping patients avoid untold complications of their chronic conditions. Cather doesn’t want to think about what might have happened to Matt if his leg swelling had gone unchecked. “He’s diabetic, so if it was a circulation problem, it’s scary to think about where that might have led,” he says.
In a health system where it can take weeks to see a doctor, pharmacist-provided care is essential, Cather says. “Whether you’re in a rural area or a metropolitan area, access to care through a pharmacist is easier. They are in to pick up their medications every four weeks, we have a good relationship with them, and they trust us.”
Provider status stories
Pharmacists are health care providers. In a series of profiles appearing in Pharmacy Today and on pharmacist.com, pharmacists explain how their patients would benefit from provider status. And as part of our campaign for provider status, APhA has asked pharmacists to share their story of how they provide care to their patients and how provider status will improve health care. These stories are collected on the APhA YouTube channel at https://www.youtube.com/user/aphapharmacists/playlists. If you would like to share your story, please visit PharmacistsProvideCare.com.