Medications are a primary therapeutic option for patients. Despite advances in treatments and growing evidence supporting best use, gaps in care related to medication use remain, resulting in substantial patient burden (cost, morbidity and mortality) and economic waste in an already stretched healthcare ecosystem. Within the modern healthcare environment, real-world evaluation studies provide evidence of effectiveness of therapy and gaps in care, new and evolving models of healthcare delivery offer hope of improved outcomes, and implementation of optimal and nimble models of care afford insight into improving medication use.
The Center for Pharmacy Innovation and Outcomes (CPIO) was established in 2015 in partnership with Geisinger’s Enterprise Pharmacy, which oversees system-wide medication use platforms in acute, ambulatory, community and managed care settings, and Geisinger’s Research enterprise. The CPIO mission is to conduct, implement, and disseminate research to optimize medication use by leveraging a highly evolved health IT infrastructure, applying robust data including patient-reported information and a growing genomic reservoir, and deploying trained and highly skilled clinical pharmacists.
The CPIO’s research focuses on meaningful improvement of population health management and value in healthcare as related to medication use. The CPIO uses scientific principles to evaluate and disseminate innovative pharmacy services, reduce the burden of medication nonadherence, pain and addiction, and personalize medicine through the application of pharmacogenomics.
- Benjamin Andrick, PharmD, BCOP
- Michael Gionfriddo, PharmD, PhD
- Jove Graham, PhD
- Adam Gross, PharmD, CCRP
Selected Initiatives and Projects
Improving Transitional Care through Communication between Pharmacists
In an effort to cut the rate of preventable rehospitalizations for patients discharged from Geisinger facilities, researchers in the CPIO have initiated a study supported by the National Association of Chain Drug Stores Foundation evaluating the impact of pharmacist transmission of information from the inpatient to the outpatient setting on patient outcomes.
Pharmacist-led Familial Hypercholesterolemia Multidisciplinary Clinic
In collaboration with primary care providers and specialists at Geisinger, we are developing a patient and family member care process for our patients diagnosed with familial hypercholesterolemia. The Medication Therapy Disease Management (MTDM) pharmacists are providing medication reviews and adjustments to help patients reach their treatment goals.
Hematopoetic Cellular Transplant Medication Therapy Disease Management Program
Hematopoetic cellular transplant (HCT) is a commonly utilized treatment modality for the treatment of patients with specific hematological malignancies. To date, most transplants at Geisinger have been the infusion, not transplantation, of the donor’s own hemotopoetic stem cells. However, by transplantation of donor stem cells, an immunological response can be induced resulting in a durable remission and potentially, a cure. This project seeks to implement a HCT medication therapy disease management program at Geisinger to improve clinical and quality outcomes for the medically complex stem cell transplant population. This pilot will provide, and justify, the best clinical pharmacy services for the HCT patients at Geisinger since there is no established longitudinal pharmacy service today.
Within the past 15 years, the United States has witnessed a 300 percent increase in the incidence of deaths due to prescription drug overdose. A common source of prescription drugs is the medicine cabinet where unused, unwanted or expired medications account for a large component of the abused supply. Geisinger has conveyed a Medication Take-Back team to lead a multi-disciplinary coalition dedicated to reducing the impact of unused, unwanted, expired medications on public health (namely drug addiction) and the environment through improved community awareness and increased convenience of proper medication disposal. Medication collection units are being placed at convenient locations throughout communities across the greater central and northeast region of Pennsylvania. CPIO researcher, Eric Wright is leading the effort to study the effects of the increased access to proper disposal. Learn more at: www.geisinger.org/takeback.
Geisinger opened a pharmacist-led Medication Therapy Disease Management (MTDM) Chronic Pain Clinic in 2012 to help patients better manage their pain and identify/prevent addiction. The multidisciplinary clinic is comprised of administrators, primary care and interventional pain physicians, pharmacists, registered nurses and social workers/addiction counselors. Our goal is to help patients decrease their pain so they can reach important life goals.
Closing the Know-Do Gap for Treatment of Familial Hypercholesterolemia
FH affects nearly 1 million Americans and half of these individuals are untreated. Individuals with FH have elevated low-density lipoprotein cholesterol from birth that substantially increases their risk for cardiovascular (CV) events as early as 20 years of age. Medications exist to reduce the risk of CV events. Funded under the NIH K12 Mentored Training in Implementation Science (MTIS) career development program, Dr. Laney Jones’ research will seek to promote uptake of evidence-based treatment for FH by assessing the barriers and facilitators to FH care and designing and evaluating the feasibility of an implementation strategy.
Having a complete, accurate medication list that is transparent to healthcare providers and the patient is the principal goal in designing MedTrue™. In a multidisciplinary effort led by Eric Wright, MedTrue™ is a comprehensive medication adherence database and web-based application intended to serve as a single source for medication reconciliation, adherence monitoring and patient engagement support to help improve primary and secondary adherence.
Optimizing High-Cost Biologic Treatments for Patients with Multiple Sclerosis
Patients at Geisinger with multiple sclerosis receive reliable delivery of best practices through an evidence-based care process that seeks to treat patients based on their individual disease progression and severity in a standardized manner. This study aims to evaluate clinical outcomes, prescription trending, and total cost of care for patients with MS before, after, and without the implementation of the MS care process.
Real-World Outcomes, Medication Adherence and Cost among Patients with Multiple Sclerosis using Disease Modifying Therapies
MS is the second most common cause of disability among young adults. It is a costly chronic disease with total annual costs per affected individual exceeding $50,000, which is comparable to congestive heart failure. Although high-cost, disease-modifying therapies (DMTs) are frequently used in the management of MS due to their effectiveness at decreasing relapses, lesion burden on magnetic resonance imaging, and disability. Most studies highlight the association between real-world rates of adherence to DMTs and relapses, healthcare utilization, and economic outcomes but have not evaluated clinical and cost outcomes for a population on a broad range of DMTs. This retrospective study will describe the prescription and testing patterns of DMTs and assess the relationship between DMT adherence, clinical outcomes, and healthcare costs among patients with MS at Geisinger.