University Hospitals (UH) in Cleveland is integrating pharmacists directly into primary care teams across 17 locations, aiming to enhance chronic disease management and reduce medication-related complications.
This innovative model reflects a growing national trend toward team-based care, where pharmacists play a proactive role in managing complex medication regimens, educating patients, and collaborating with physicians to optimize treatment plans.
Program Overview
- UH has embedded clinical pharmacists into 17 primary care practices.
- These pharmacists work alongside physicians, nurses, and care coordinators to support patients with chronic conditions such as diabetes, hypertension, and heart failure.
- The initiative is part of UH’s broader strategy to improve population health, reduce hospital readmissions, and enhance medication adherence.
Role of Embedded Pharmacists
- Medication therapy management: Pharmacists conduct comprehensive reviews to identify drug interactions, duplications, and opportunities for deprescribing.
- Patient education: They counsel patients on proper medication use, side effects, and lifestyle modifications.
- Collaborative care: Pharmacists participate in care team huddles and contribute to shared decision-making.
- Monitoring and follow-up: They track lab results, adjust dosages, and ensure patients meet therapeutic goals.
Impact and Outcomes
- UH reports that embedding pharmacists has led to improved clinical outcomes, especially in managing A1C levels for diabetic patients.
- The model has also helped reduce emergency department visits and hospitalizations linked to medication issues.
- Patients benefit from more personalized care, and providers gain support in managing increasingly complex therapeutic regimens.
Strategic Rationale
- With rising rates of chronic disease and polypharmacy, UH recognized the need for medication experts within primary care.
- Pharmacists bring specialized knowledge that complements physician expertise, especially in managing high-risk patients.
- Embedding pharmacists aligns with value-based care goals and supports risk stratification and care coordination.
Broader Implications
- UH’s model could serve as a blueprint for other health systems seeking to integrate pharmacy services into outpatient care.
- It reflects a shift from reactive to preventive care, where pharmacists help identify and resolve issues before they escalate.
The initiative also highlights the evolving role of pharmacists as clinical partners, not just dispensers.