Rockford FD Adds Pharmacists to MIH Mix

As mobile integrated healthcare grows in popularity throughout the U.S., each new program looks a little different, based on the community it serves. The Rockford, IL, Fire Department (RFD) is piloting an MIH program that looks like many others in that its teams include emergency medical services (EMS) staff and registered nurses. But RFD MIH teams also include pharmacists, creating additional opportunities to help patients manage their health. Here’s a look at RFD’s model.

Laying the Groundwork

RFD provides EMS and fire services to a population of 150,000, with annual volume exceeding 26,000 calls. Of the patients RFD EMS transports, half are evaluated at Swedish American Hospital (SAH). Together, RFD and SAH identified “superusers”—patients who were transported to the hospital’s emergency department (ED) 10 times or more per year—and looked for ways to:

• Decrease unnecessary EMS transports;
• Reduce ED evaluations that could have been managed in the field;
• Allow RFD and SAH to proactively manage these patients at home.

The outcome was a six-month pilot MIH program that ends in July 2015.

Defining the Patient Population

The program’s organizers chose a subset of the super-user patient group for the MIH project. The goal was to identify those patients in whom health changes could be recognized early—before an acute episode might develop and lead to an emergency response. The patients selected for the program have multiple underlying medical conditions, including:

• Cardiac pathology;
• COPD;
• Renal failure;
• Diabetes;
• Congestive heart failure.

The initial pilot group was small—just 12 patients. Home visits to these patients could be scheduled to occur on a weekly basis. Depending on the situation and need, follow-up phone calls could be scheduled as an alternative. “Each client’s primary-care physician is included in the exchange of information,” says Lt. Robert Vertiz, who is RFD’s EMS training coordinator and the primary project manager for the pilot.

A Unique Staffing Model

The RFD MIH staffing model includes an EMS provider (EMT-Paramedic), an RN and a pharmacist. “The [inclusion of] pharmacists was proposed by Swedish American Hospital, in hopes to be able to identify needs and [provide]education to the patient and make sure there is coordination between all providers,” says RFD Chief Derek Bergsten.

It also capitalizes on the population’s trust in the profession. In December 2014, pharmacists came in second—right behind nurses and tied with doctors—in a Gallup poll that asked Americans to rate the honesty and ethical standards of members of various professions.1 And, as B. Douglas Hoey, CEO of the National Community Pharmacists Association, noted in Drug Topics magazine in 2013, “The combination of their goodwill with consumers, extensive training, medication expertise and easy accessibility has pharmacists perfectly positioned to play a larger role in the U.S. healthcare system.”2

Each member of the team contributes a different aspect of the patient’s total care.

The pharmacists are from SAH. Being on site allows them to see the patients in their home environment. This is significant in terms of the patient’s medication compliance, especially if the patient has multiple conditions and takes numerous medications. Prior to going on-scene, the pharmacist reviews the patient’s medications, such as doses, indications and contraindications. While on-scene, the pharmacist can provide additional patient education specific to the medications. If a prescription needs to be updated (for example, a change in dose), the pharmacist can notify the PCP and potentially avoid the need for the patient to be transported to the physician’s office for evaluation.

The RNs are experienced ED nurses, also from SAH, who are involved in case management. They are familiar with the patients in the project from past interactions with them in the ED. The nurses are able to provide a detailed patient assessment in the patient’s home, similar to a traditional ED assessment. They can also coordinate assignment of a PCP if the patient doesn’t have one.

EMS providers assist with scene logistics, patient assessments and treatments. Their role as members of RFD appears to have led to easier acceptance by patients, who view the fire department as a “trusted” organization. RFD staff leverage their time in the patient’s residence by conducting home safety surveys that include checking smoke detector batteries; providing smoke and carbon monoxide detectors, bathroom scales and shower chairs when needed; and inspecting for objects or conditions that can result in trips and falls.

Early Signs Point to Success

Patient feedback on RFD’s MIH program to date has been positive, with reports that the home visits support the patients’ self-worth and self-esteem. Patients also report looking forward to the home visits and interacting with the MIH team, knowing they are being cared for. “We don’t always have to see a drastic decrease in ambulance transport volume or emergency department visits in order to declare this program a success,” Vertiz says. “Identifying our clients’ needs and taking care of them in a way that benefits and improves their lives defines the program’s success.”

Bergsten adds, “The results to date definitely do show that we are meeting the objectives set for the trial period. We are very excited about the results and the actual feedback from the citizens. We are making an impact on improving their health.”

Paul Murphy, MS, MA, paramedic, has administrative and clinical experience in start-up and established healthcare organizations.