NYC Health + Hospitals today announced that it has expanded the role of its clinical pharmacists to help patients manage hypertension. The public health system’s clinical pharmacists work closely with primary care teams, and had previously just focused on diabetes care management. There are more than 98,000 New Yorkers diagnosed with hypertension who receive care in the City’s public hospitals and community-based health centers. Clinical pharmacists act as part of patients’ care teams, but operate independently to assist patients with uncontrolled hypertension or complicated hypertension medication regimens, to manage their medications between primary care visits with their doctor. Clinical pharmacists are certified to adjust, stop or start any medications related to the disease they are treating. The City’s public health system launched its clinical pharmacist program in March 2019 to improve patient experience and to help patients manage their diabetes. Clinical pharmacists at NYC Health + Hospitals will begin to treat patients for hypertension by spring 2020. The integration of clinical pharmacists to help manage chronic diseases is part of the health system’s broader multi-year redesign to build a competitive, sustainable organization that will continue to offer high-quality and accessible health care to the people of New York City.
“The expansion of our clinical pharmacists’ role demonstrates how NYC Health + Hospitals is making efficient care more accessible to patients,” said Ted Long, MD, MHS, Vice President for Ambulatory Care at NYC Health + Hospitals. “Managing chronic diseases can be challenging for some, creating reoccurring doctor visits and creating some backlog in scheduling. Utilizing all appropriate health providers is crucial in streamlining care and ensuring patients are seen when they need for exactly what they need.”
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“NYC Health + Hospitals prides itself in meeting patients where they need healthcare, meaning in different settings and capacities,” said Hannah Jackson, MD, MPH, Senior Director of Ambulatory Care Innovation at NYC Health + Hospitals. “Managing chronic diseases can be challenging, but accessing the care you need shouldn’t be. The City’s public health system is finding ways to streamline care as much as possible to fit New Yorker’s lifestyles, and the expansion of the role of clinical pharmacists is just one example.”
“We’ve come to understand that managing chronic diseases is not a one size fits all, and there isn’t a quick fix to medication,” said Jason Lee, Pharm.D, a Clinical Pharmacist at NYC Health + Hospitals/Bellevue. “Medicine that helps control chronic diseases need to be adjusted regularly. Clinical pharmacists play an integral role in keeping the patient and the primary care provider focused on how medication management can have a positive impact on managing chronic diseases.”
Patients are referred to clinical pharmacists by their primary care physician after diagnosis to help manage their chronic disease medications, streamlining the care process. Since March, 420 unique patients with diabetes have been treated by a clinical pharmacist to help manage their chronic disease. Of those patients, about 83 percent saw a reduction in their blood sugar levels (A1c levels). The average reduction was 1.58 percent, which is a significant reduction across the board, with many moving from “uncontrolled” to “controlled” diabetes by health metric standards.
During a visit, a clinical pharmacist reviews the patient’s blood sugar levels, evaluates their medications and, if necessary, adjust dosages and combinations to help control A1c levels. In addition to medication adjustments, the clinical pharmacist identifies barriers the patient might face in taking their medication (i.e. shelter insecurities, cost), teaches them to use certain medications like insulin injections, discusses diet and exercise changes, and provides education on how the combination of lifestyle and medicine work together for better outcomes.
As part of NYC Health + Hospitals’ emphasis on improving both diabetes and hypertension outcomes, the expansion of the clinical pharmacist’s role to include hypertension was evolutionary. Approximately 120,500 of NYC Health + Hospitals patients are diagnosed with diabetes and hypertension. Moreover, a number of the diabetic interventions – lifestyle changes and medication adherence techniques – can also be used for hypertensive patients.
Today, there are 11 clinical pharmacists at NYC Health + Hospitals/Bellevue, Harlem, and Queens, as well as NYC Health + Hospitals/Gotham Health, Gouverneur and Morrisania. The public health system is investing approximately $3M to help hire a total of 20 clinical pharmacists as part of the first phase of implementation, and hopes to add additional chronic diseases to the portfolio aside from diabetes and hypertension. Clinical pharmacists will be integrated in all acute-care facilities by the end of 2020.
Approximately 1,847,000 New Yorkers have hypertension, according to the NYC Department of Health and Mental Hygiene, with higher rates for those above the age of 45. According to a study published in the Journal of the American Heart, Black adults are up to two times more likely to develop high blood pressure by age 55 compared to whites. The average medical expenditures for people with diagnosed hypertension are about $2,000 more annually compared to those without. Uncontrolled hypertension can lead to stroke, heart attack, heart failure and other heart conditions; cause damage to your kidneys, memory and vision.
NYC Health + Hospitals is the largest public health care system in the nation serving more than a million New Yorkers annually in more than 70 patient care locations across the city’s five boroughs. A robust network of outpatient, neighborhood-based primary and specialty care centers anchors care coordination with the system’s trauma centers, nursing homes, post-acute care centers, home care agency, and MetroPlus health plan—all supported by 11 essential hospitals. Its diverse workforce of more than 42,000 employees is uniquely focused on empowering New Yorkers, without exception, to live the healthiest life possible. For more information, visit www.nychealthandhospitals.org
Photo credit: Harlem Hospital.