Primary Care: The CCA Way

Hello friends!! There are severe thunderstorms in Boston right now and I’m too scared to venture out for my evening commute, so you all get a blog posting! How lucky! I was going to meet my new friend Danielle, a Nurse Practitioner at Commonwealth Care Alliance (CCA) for dinner, but we shall see what the weather has to say about that!

Speaking of Danielle, though- I had the opportunity to meet her when I went shadowed her on home visits. My boss thought it would be useful for me to see firsthand how we provide care to our members and he was definitely right! Danielle acts as a care manager for her patients, as an integral part of their primary care team. She is responsible for about 20 patients and provides care to them in their homes (be it an apartment, assisted living facility- anywhere). She has the flexibility to schedule her time as she sees fit, enabling her to adjust her appointments as patient acuity dictates. You can see a video of a CCA nurse practitioner visit here.

We started out our day at the Somerville Home, a residential care facility. We met with two of her patients in the nursing station there which allowed for communication with the nursing staff at the facility, giving us some insight into their daily condition. Danielle suspected one of the patients might be under-reporting their pain, but the Somerville Home nurses let us know how she feels throughout the day, allowing Danielle to appropriately adjust her medications. She typically visits her patients once a month, but one of the patients we visited is relatively new to her so she wanted to go back in two weeks to make sure she understands all of her conditions and to help build her relationship with her. It was exciting for me being there, as I was able to provide some drug information relating to which drugs might be causing certain symptoms.

Next, we were off to the Cambridge Hospital as she had admitted one of her patients the day before. She likes to check up on all of her patients when they are in the hospital, to check on them and to communicate with the hospital staff so they are well informed about the patient’s conditions. While there, she spoke with the patient’s nurse, the patient and the patient’s daughter, who is her primary caregiver in the community. She was also able to speak with the case manager to begin her discharge planning for when her condition was sufficiently stabilized. After patient’s are discharged, Danielle makes it a priority to visit them within 48 hours to ensure everything was well coordinated. After our P3 Direct Care IPPE’s, where we performed medication reconciliation, I realized right away what a great idea this is! If anything slips through the cracks during her transition back home, Danielle is able to catch it right away.

Finally, we visited a patient in her apartment. While there, we discovered that she had some piroxicam from several years ago. Danielle and I talked about it with the patient (it was nice to have some knowledge of the drug- it has a very long half-life and is definitely a drug to avoid in the elderly!) and decided to adjust the timing of her other medications and avoid the piroxicam altogether. Had we not been providing care to the patient in her home, however, I think this medication could have been missed, possible leading to a very serious adverse drug reaction.

In summary, I had a great day! It was so fun being out on the road with Danielle, meeting some of our members firsthand. It got my mind going about the possibility of adding a pharmacist to the CCA primary care teams, seeing how useful it was for Danielle and I to discuss the patients’ medications.

UPDATE (since I didn’t actually post this last night): I was able to make it safely to Danielle’s for dinner and we had a wonderful time!