Signing Out From Boston!

Hello friends!! The summer is winding down and this is the last post you are going to see from me here. Fear not- if you miss me you can head on over to the P4 rotation blog to catch up on all of my latest adventures! I cannot believe how quickly this summer went- three months just isn’t enough (sorry to all the rest of the classes who won’t even have that!)


This summer I have been working to develop a couple of quality improvement projects. The first one focused on stroke prevention in atrial fibrillation. Basically, the guidelines say that if a patient with atrial fibrillation is at risk for stroke they should receive oral anticoagulation (traditionally with warfarin). This becomes quite difficult in our members, however, as they are all elderly and many are disabled. They have difficulty complying with the monitoring requirements of warfarin, are often treated with interacting medications and are also at a high risk for falls and subsequent bleeds. With the approval of the new direct thrombin inhibitor, dabigatran (Pradaxa) in October, our clinicians now have another option for anticoagulation in this population. We identified members who had a diagnosis code for atrial fibrillation and determined their stroke risk through the use of a CHADS score (this looks at whether a patient has congestive heart failure, hypertension, is over age 75, has diabetes or has had a previous stroke). We were able to use pharmacy data in order to determine whether they were receiving warfarin, dabigatran or aspirin and from this, we developed our best guess of which patients could benefit from therapy with dabigatran. I worked to create educational material for our clinicians and to draft communications to be sent out to each of the identified patients’ primary care physician. Next year they will pull this data again and see whether a higher percentage of patients are now being appropriately anticoagulated. I wish I were staying longer so that I could be involved in the education efforts and to see the effect that all of these efforts have on patient care!

I’ve also been working on some smaller projects. I have created reports to send out to all of the different sites regarding patient adherence and cost effective prescribing. I drafted letters to be sent out to our members (after CMS/MassHealth approval of course!) regarding MTM services and regarding changes in coverage. I also drafted communications to our clinicians regarding the new simvastatin dosing guidelines.


My final project has been attempting to develop a polypharmacy quality improvement project. So far, I have done a literature review of all the different tools that exist to assess polypharmacy (this turned out to be a huge amount of information!) Tomorrow I’ll be meeting with our pharmacy director and the medical affairs department so that we can develop criteria for the identification of members to target and what intervention we can use. We will also need to identify indicators so that we can assess the progress of the project after implementation. I will definitely not be around when this project is rolled out but I have still learned so much from working on it!


I have enjoyed my summer at CCA immensely! I love thinking about the unique pharmacy issues that the elderly population faces and am definitely thinking about steering my career in that direction. I can’t wait for my rotations coming up this year where I can start to delve into this interest- see me jumping for joy?!