Blue Care Network Best Practices
Ann Arbor practice monitors persistent medications in the best interest of the patient
At Ann Arbor Family Care, Karl J. Edelmann, M.D., has a standard protocol for patients on chronic medications that can cause metabolic abnormalities or other side effects: They are monitored every four months.
Healthcare Effectiveness Data and Information Set® measures track annual monitoring of patients on certain types of medications. More than 700,000 Americans visit an emergency room each year due to adverse drugs events or other incidents related to prescription drugs, according to the National Committee for Quality Assurance.
"Medication guidelines indicate that you should check labs at least twice a year," says Dr. Edelmann. "By setting the timeline at four months, if a patient misses one lab work, he or she would still have blood drawn twice a year."
For cholesterol and diabetic patients, Dr. Edelmann mails a card to the patients with their numbers so the patient can use it for reference.
"Even though I’m using monitoring to get my patient in the room, what I’m really doing with that visit is monitoring their weight, checking blood pressure and lifestyle changes. It’s an opportunity to review alcohol use and exercise activity, for example. Even though the patient’s purpose for the visit is their cholesterol, for me the visit is an opportunity to discuss other issues."
The importance of monitoring patients on certain medications cannot be overemphasized. Dr. Edelmann notes that there have been occasions where he has stopped medication or switched medications when blood work indicated problems with liver or kidney function.
"If I have a patient who is either noncompliant or whose diabetes is progressing and I see a change in liver function or glucose values, I may need to change their medication," he explains. Dr. Edelmann said he may also need to stop medication when there are contraindications.
Occasionally, a patient can be taken off certain medications. "When a diabetic is working on diet and exercise and his sugar is well controlled, I may take them off medication," continued Dr. Edelmann. "I get dinged for it on my quality scores, but I’m doing what’s best for the patient."
Dr. Edelmann says the key is knowing your patients, having protocols in place and having the flexibility to deviate from protocol when it’s in the best interest of the patient.
Getting lab work completed on time for visits represents the biggest challenge for Dr. Edelmann. The office requests that patients get their blood drawn a week before their visit. "If they wait a few days prior to the visit, it may take up to 45 minutes to get the results and it puts the office behind schedule," says Dr. Edelmann.
Noncompliant patients also present challenges for the practice. The office refuses refills for patients that have not completed their blood work.
Sometimes patients are chronically noncompliant or don’t take medication correctly. After the second time the patient misses getting their blood work done in a timely manner, Dr. Edelmann will only give the patient a four-month refill at a time. "They physically have to come and get their prescription," he says.
While Dr. Edelmann doesn’t offer formal patient education, part of the reason he brings them in is to counsel them. "If I have someone who doesn’t understand why they need blood work every four months, I explain it to them," says Dr. Edelmann. "For patients who have been stable, I will allow them to go six months. But if they miss one lab, they need to go back to the four-month schedule."
On occasion, Dr. Edelmann encounters a situation that requires a novel approach.
"I treat a corporate executive who was always too busy to come in," he says. "I could never drag him in here until I got the number for his personal secretary. I limited his refills. Then I worked with the secretary to schedule appointments and blood draws. Sometimes we have to be creative to meet patient’s needs, but my system works for 95 percent of my patients."