Patient Self-Management Credentials
The Patient Self-Management Credential (PSMC) is a psychometrically validated tool developed by the APhA Foundation that empowers health care providers (HCPs) and patients to work together in meaningful and efficient ways to identify and address areas for improvement in the self-management of chronic diseases.
Patient credentialing is a unique concept where patients’ knowledge of their disease, lifestyle requirements, and therapy adherence strategies are assessed so HCPs can tailor education, support and care that effectively meets the specific needs of individual patients. Patients are also assessed on the skill set needed to effectively manage their chronic disease and how well they consistently perform those skills and work toward ongoing self-management. With a progressive evidence-base that has evolved over the past 14 years, use of the PSMC has consistently produced patients that are more engaged and empowered to manage their own health care.
Knowledge Assessment
The Knowledge Assessment is a multiple choice questionnaire that focuses on the basics of diabetes care. Patients’ responses help providers identify areas of primary focus for education efforts, which leads to mass customization of care. There are 6 sets of Skills Assessments focusing on core techniques of diabetes management. Patients demonstrate these skills for their provider during face-to-face encounters. Performance Assessments allow for a routine check to assure patients are following through with regularly employing their diabetes self-management knowledge and skills.
As patients work through the assessments with their providers, they “graduate” from Beginner to Proficient and eventually Advance based on their knowledge, skills, and performance on specifically designed assessments at each stage. Providers utilize their clinical judgment to determine if a patient should receive more education and be re-assessed or if they are proficient enough to move onto the next domain.
Frequently, patients visit with their providers more often when they are in the Beginner phases so that providers can work with the patient to support mastering various components of self-management behavior. As patients work through the process and eventually reach Proficient in the Performance phase, their number of provider visits can decrease since their chronic disease is well-controlled.
Project Summary
In 2002, the APhA Foundation developed a pilot program entitled Patient Self-Management Program for Diabetes (PSMP Diabetes). Patients were enrolled in an interdisciplinary care program designed to allow pharmacists to assess patients’ diabetes self-management knowledge, skills and performance by using the Patient Self-Management Credential for Diabetes. After 12 months, results showed that patients’ key indicators of diabetes had improved, patient satisfaction with their care had increased and overall health care costs were reduced.
This successful model was then effectively scaled through the development of the APhA Foundation’s Diabetes Ten City Challenge. Ten cities utilize a patient credentialing process modeled on the PSMP Diabetes program and demonstrated similar clinical and economic results. Most recently, the PSMC has been used in Project IMPACT: Diabetes, in which 25 communities utilized the tool with patients disproportionately affected by diabetes in an effort to provide mass customization of diabetes care across disparate populations.
Looking to the Future
Credentialed patients may be more likely to:
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adhere to providers’ recommendations for lifestyle modifications and medication regimens;
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research and explore different treatment options;
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communicate goals, concerns, and desires in a more actionable way with providers;
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engage and take charge of their health.
PSMC In Primary Care
Goal
To build on the success of the PSMP Diabetes program and migrate its adoption into other clinical environments, through an innovative partnership to collectively utilize resources creating a more robust framework for patients to become credentialed self-managers of their diabetes care.
The Participants
Supported by Sanofi
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National diabetes and patient organizations (e.g. AADE, AACE, Diabetes Hands Foundation)
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A major health system and payer (TriHealth)
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A community pharmacy chain (Kroger)
About the Initiative
The APhA Foundation, in partnership with Opus Science, has tested the use of the PSMC in 8 physician office practices in the Cincinnati area. Physicians provided valuable feedback about the online platform and use of the PSMC within their primary care settings. The APhA Foundation is currently utilizing that input as well as other feedback gathered within Project IMPACT: Diabetes to redesign the web-based credentialing tool and build out a communications hub to facilitate multi-disciplinary collaboration around PSMC results. A streamlined training program will accompany the new platform, which is anticipated to go live in late 2014.
Partnering with PrescribeWellness
Goal
To integrate the PSMC into diabetes care within practices that utilize the PrescribeWellness platform.
The Participants
Prescribe Wellness
PrescribeWellness was founded by experts in marketing, technology and healthcare who came together with the common goal of improving health and wellness in America. The resulting company has helped clients across the nation achieve real results, including better patient health and lower overall healthcare costs for patients who receive communications through PrescribeWellness.
About the Initiative
PrescribeWellness is integrating the PSMC into their online PeakWellness platform for broad delivery to pharmacy customers who are focused on managing chronic disease. The business relationship with APhA Foundation will provide an integrated way for users to utilize the PSMC within the familiar PrescribeWellness platform to which they subscribe.
Convening a Consortium of Key Stakeholders
The APhA Foundation convened a consortium to further explore challenges within the current healthcare system as well as opportunities for potential system changes. The consortium provided insights and principles that could be used to guide institutions in making value-based health benefit decisions.
Perspectives from four key constituencies were considered:
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patients who have been empowered by their providers through use of the PSMC,
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practitioners who have utilized the PSMC in their practices to customize care,
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payors who make data-driven decisions to inform their coverage, and
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value-based health decision makers from benefit managers and health systems.
Recommendations from Consortium
A synthesis of the information, opinions, and expertise that emerged from the Consortium discussion produced six key themes that provided the basis for developing a principle-centered approach that will contribute to optimizing health and costs of care.
The Key Principles for Transforming the Delivery of Patient Care that could IMPACT effective health care system changes and improve patient outcomes are to:
Inspire patients, providers and payors to transform the health care system
Make the patient the center of all health care decisions
Promote access to evidence and information that elevates clinical decision-making
Align the incentives for patients, providers and payors
Cultivate quality improvement and practice enhancement
Take accountability for the financial, clinical and humanistic outcomes of patient medication use
The APhA Foundation will continue to work with system stakeholders to develop tools and resources that will guide stakeholders on “how” to translate these principles into practice and invent a preferred future for our health care delivery system.
Expert Panel Participants
John Beckner | Senior Director, Strategic Initiatives | National Community Pharmacists Association |
Dean Benton | Clinical Coordinator | Dillons Pharmacy |
Benjamin Bluml | Senior Vice President, Research and Innovation | APhA Foundation |
Kelly A. Brock | President | KB Pharmacy Solutions |
Barry Bunting | National Practice Leader, Health Plan Innovation | Ateb |
Mark Cziraky | Vice President of Research | HealthCore, Inc., an Anthem Company |
John Forbes | Owner | Medicap Pharmacy |
Scott Hamstra | Infectious Disease Specialist | U.S. Indian Health Service |
Elizabeth K. Keyes | Executive Director | APhA Foundation |
Sandra Leal | Vice President for Innovation | SinfoniaRx |
Thomas Menighan | Executive Vice President and CEO | APhA |
Shannon Peter | Clinical Pharmacy Manager | Think Whole Person Healthcare |
Pete Sheldon | Vice President, Education & Patient Engagement | Med-IQ |
Steve Simenson | Managing Partner | Goodrich Pharmacies |
Jaan B. Skelton | President | Silver Pennies Consulting |
Parisa Vatanka | Project Development Manager | APhA Foundation |
Tery Baskin | President and CEO | RxResults |
Amanda Applegate | Pharmacy Clinical Services Coordinator | Balls Food Stores |