Impact Projects

Impact Projects

Goal of IMPACT:

To improve patient outcomes by optimizing drug therapy through a community practice model that integrates pharmacists into family practices.

Model Development


How Was the IMPACT Model Developed
System Facilitation
Seamless Care: The Pharmacists' Role in Maintaining Continuity of Patient Care
Discovering the Value of the Family Practice Pharmacist
Improving Drug Therapy with Medical Informatics
Ministry Approves enhanced funding for IMPACT

How Was the IMPACT Model Developed

Seniors Medication Assessment Research Trial (SMART), a large community-based randomized controlled trial was completed by McMaster University Department of Family Medicine.

In SMART, seniors on multiple medications were referred for a consultation with a specially trained pharmacist in physicians' offices. After the consult the pharmacist telephoned patients twice and revisited the family physician once to discuss their recommendations.

Physicians were receptive to solving drug-related problems, suggesting collaboration between physicians and pharmacists is feasible. For more information on the SMART Project, visit: Past Projects

(IMPACT strengthens and expands upon the SMART interventions in the following ways:

  • Integrating pharmacists into the practice will facilitate collaborative working relationships between pharmacists and physicians, office staff and patients.
  • Trust within the working relationships will facilitate the uptake of recommended therapeutic strategies to help address drug-related problems.
  • The link to Drug Information expertise will increase the pharmacists' efficiency and provide physicians with up-to-date, easy-access drug information resources.
  • The intervention includes evidence-based practice change strategies such as interdisciplinary face-to-face interaction, patient-specific audit and feedback, educational detailing and consensus building for medication management system innovation.
  • Training and mentoring will enhance the integrated pharmacists' patient assessment skills and familiarity with family physician office practice.

IMPACT will explore physician initiated and indicator-initiated methods of patient referral. The project will remain flexible to facilitate the integration of the pharmacist into unique family practice contexts.
C. Sellors, BScPhm
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System Facilitation

Implementing evidence into practice is a complex task. Historically, programs have attempted to modify physician behavior by addressing physician knowledge. Traditional knowledge translation and practice guidelines, however, have not proven effective in enhancing physician performance in prevention.

Facilitation is defined as the ability "to make easier." It acts as a primary catalyst for change. In the Ottawa Model of Facilitation a trained facilitator assists family physician practices by tailoring strategies to meet the needs of each practice. The foundation of the intervention rests on evidence-based guidelines and evidence-based tools, but a key to success is the trusting relationship between the facilitator and the members of the practices' interdisciplinary team. A strong partnership promotes and supports systemic change, marrying the unique practice needs and goals.

Optimizing drug therapy and preventing drug related problems is a large part of family practice. IMPACT aims to intervene at the patient level (medication assessments) and the practice system level (facilitation). IMPACT's specially trained pharmacists offer a unique opportunity to develop innovative drug-related systems. Building on the success of Ottawa's facilitation research, integrated pharmacists will work with the practice team to develop drug-related office systems aimed at optimizing drug therapy in community family practice.
Kevin Pottie MD, Eileen RN
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Seamless Care: The Pharmacists' Role in Maintaining Continuity of Patient Care

Substantial communication barriers exist between hospital and community-based primary health care providers. Hospital physicians dictate a discharge communication to family physicians which can take a month or two to arrive. Community pharmacists receive prescriptions but no diagnosis or indication for medications. These communication gaps can lead to treatment discrepancies and medication-related problems.

Seamless pharmaceutical care involves the practice of pharmaceutical care in a continuous manner delivered to a patient across the spectrum of caregivers and environments. Family physician practices are central to ensuring seamless care. Studies have demonstrated that seamless pharmaceutical care for hospitalized general medical patients reduces the number of drug discrepancies and improves patient recall of medication regimen. One study compared usual care to an intervention: pharmacist counseling, completion of a discharge summary which the patient shared with both his/her family practitioner and community pharmacist, and pharmaceutical counseling at follow-up and three months. Patients in the intervention group demonstrated better medication knowledge, better compliance, and had fewer physician visits and hospital readmissions 1.

Seamless care can include the timely transfer of information between hospital and community, improved communication between hospital and community pharmacists, and discharge summaries which are given to the patients. These collaborative interventions can improve patient care, patient outcomes, and reduce health care costs. Seamless care is one role for pharmacists working in primary care office practices.
A. Kirsten Woodend, RN, MSc, PhD, University of Ottawa

(1) Al-Rashed SA, Wright DJ, Roebuck N, Sunter W, Chrystyn H. Inpatient pharmaceutical inputs to facilitate seamless care. The Pharmaceutical Journal 2000; 265(7114):R60.
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Discovering the Value of the Family Practice Pharmacist

"I had no clue of pharmacists' breadth of expertise and skills, skills which could be used to vastly improve patient care well beyond what most physicians can provide. It had never occurred to me that a pharmacist could give detailed analyses and consultation on complicated pharmacotherapy, especially in the populations of chronically physically and mentally ill patients of the inner city population."

Dr. Philip Berger, family physician, St. Michael's Department of Family and Community Medicine. St Michael's family medicine teaching practice, an inner city practice in downtown Toronto, has had a clinical pharmacist for 10 years.

As the current clinical pharmacist, I contribute to patient care by providing individual medication assessment sessions, telephone follows-up to ensure that patients medications are working, tolerated and convenient, and I frequently see complex or high risk patients for follow-up visits. I also coordinate community resource services for medication-related issues.

In addition, I serve as a drug information resource to physicians, nurses and other health care professionals at the unit, keeping them up to date on new therapies or reviews of standard therapies.

This range of academic and clinical services has made me feel like a valuable member of the clinical team, appreciated by patients and physicians alike.
Natalie Kennie Pharm D
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Improving Drug Therapy with Medical Informatics

Identifying potential drug related problems, preventing medication errors, and translating on-going medication knowledge to the practice systems remain a challenge in family practice.

A networked computerized medical record offers several opportunities to improve drug therapy and facilitate the integration of a pharmacist in the practice system.

In several IMPACT project sites we are discovering the value of improved physician-pharmacist communication with internal e-mail and the clinical value of linking clinical questions with a patient's electronic record.

Along with assessing the drug-related information technology (IT) needs of physicians and pharmacists, we are exploring the implementation of some basic information technology enablers. These enablers will help identify how IT can facilitate patient care for physicians and pharmacists.

One promising outcome is the development of an enhanced prescription which provides improved information communication to community pharmacists in an effort to decrease medication errors and non-care enhancing call backs from community pharmacists.
Kevin Pottie MD
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Ministry Approves enhanced funding for IMPACT

The Ontario Ministry of Health and Long-term Care have approved a proposal to enhance the funding to the IMPACT project. Keeping the pharmacists active in the practice sites will allow IMPACT to continue to collect outcome data on chronic conditions (hypertension, diabetes mellitus, hyperlipidemia) and determine the full benefit of the pharmacist integration after the working relationship has been established (e.g. patient outcomes after 1-2 years vs. 6 months). This extension will also allow for on-going evaluation and better understanding of the process integrating pharmacists into group family practices.

The funding will also help further develop the IMPACT Pharmacist Training program to increase capacity to provide pharmacists with the needed knowledge and skills to participate in integrated primary care practice models. The creation of a practice innovation guide will facilitate the system level integration of pharmacists and innovative changes in medication use processes to optimize medication use.
Connie Sellors BScPhm
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