Written Proposal Happy Heart Hypertension Clinic

Business
Plan

December
12,
2014

Vivian
Nguyen,
Pharm.
D.,
BCAP

Matthew

Stailey,
Pharm.
D.,
BCAP

Vivian-‐ta-‐nguyen@ouhsc.edu

Matthew-‐Stailey@ouhsc.edu

[P]
405-‐219-‐1630

[P]
918-‐519-‐3554

Thanh
Thy
Tran,
Pharm.
D.,
BCAP

Daniel
Trobare,
Pharm.
D.,
BCAP

Thanh-‐Thy-‐Tran@ouhsc.edu

Daniel-‐Trobare@ouhsc.edu

[P]
405-‐414-‐9203

[P]
405-‐503-‐8437

6201 N. Santa Fe Ave, Oklahoma City, OK 73118 405-567-9183 405-347-8341 www.HHHclinic.com

Happy Heart Hypertension
Clinic

Happy Hypertension Clinic
2

Table of Contents
Description
of
Service

St.
Anthony
Physician
Group
North

3

Mission
and
Vision
Statement

4

Goals
of
Service

5

Scope
of
Service

6-‐11

Disease
State
Focus

Target
Population

Role
of
the
Pharmacist

Description
of
Services

Details
of
Service
Operations

12-‐16

Location
Analysis

Hours
of
Service

Projected
Patients
Reached

Projected
Staff
Employment

Impact
of
the
Service

17

Standards
of
Care

Assessment
of
Impact

Marketing
Plan

18

Documentation/Liability

19-‐24

Description
of
EMR

Continuous
Quality
Improvement
Plan

Scope
of
Practice
Agreement

Finanacial
Summary

25-‐26

Inventory
Evaluation

Certifications
Evalulation

Billing
Process

Supporting
Documentation

27

Curriculum
Vitae

Appendix

28-‐37

3

St. Anthony Physicians Group North is a multidisciplinary internal medicine practice with currently five physicians on
staff. The practice has been an established NCQA-recognized& Patient Centered Medical Home (PCMH) for three
years and is accredited as a level 2 PCMH. St. Anthony Physicians Group North has maintained level 2 standing
through its services focused on: patient-centered appointment access, electronic access to personal medical
records, thorough identification of patients for care planning and self-care support, cultural and linguistically
appropriate services, coordination of care transitions, use of clinical data and patient information to manage patient
populations, demonstrating continuous quality improvement processes and implementation of a healthcare team
that consists of social workers, dietitians, physicians, nurses, and pharmacists.
The current patient population consists of 60% Caucasian, 35% African American, and 5% other race or ethnicity.
According to electronic medical data analysis and SoonerCare Choice notification, St. Anthony Physicians Group
North has 400 patients currently with uncontrolled blood pressure (>150/>90mmHg) and concurrent medication
adherence levels that are less than 80%.
&See Appendix A
St. Anthony Physicians Group North

4

The mission of Happy Heart Hypertension Clinic is to provide accessible medical hypertension management using a
patient-centered medical home model of practice. Through open collaboration with patients and their families,
specialists and other healthcare providers, the patient remains the sole focus of care and receives the benefits of a
smooth healthcare continuum.

The Happy Heart Hypertension Clinic will be a leader in our community in improving health through delivery and
coordination of patient-centered healthcare services. Through the use of evidence-based guidelines, we will serve
as the clinic of choice in the prevention and management of complex hypertension conditions.
Mission Statement

Vision Statement

5

Our primary goal is to provide each patient with treatment specifically tailored to his or her physical, mental
and emotional needs. With a collaborative practice incorporating multiple disciplines of healthcare professionals, we
aim to provide the highest quality of patient care to the African American population in our location. Our service
focuses on identifying and treating the underlying issues that are rooted in the uncontrolled hypertension that is
prevalent in our practice community. We strive to provide a unique patient experience, where the pharmacist plays a
primary role in managing patient’s therapeutic regimens and performs appropriate interventions within a close
synergistic practice.
Following the 2014 hypertension guidelines of the Joint National Committee 8, we project to treat all 400
high-risk patients of St. Anthony Physicians Group North, recognized with blood pressure greater than
150/90mmHg, and aim obtain 65% of the population to a level of less than 140/90 mmHg within 6-months. We
seek to also increase the adherence level of 65% of the patient population to greater than or equal to 80% within 6
months.

Goals of Service

6

Among Oklahoma’s adult population, the highest hypertension prevalence is in African American patients
who are older, obese, have lower income, and have lower education. 1 Currently the Northwest and Northeast
Oklahoma City areas have the highest percentage of our target African American population. High blood pressure,
among high cholesterol, smoking, physical inactivity, obesity, poor diet, and diabetes, is a major contributing factor
to stroke. 1 In 2010, Oklahoma had the fourth highest death rate related to stroke in the United States.1 In 2010-
2012 combined, the rate of premature deaths occurring from hypertension-related heart disease was the second
highest for the African American population in Oklahoma.1
The Happy Heart Hypertension Clinic is a hypertension therapy management clinic within the St. Anthony
Physicians Group North. Adopting the Patient-Centered Medical Home principles, the Happy Heart Hypertension
Clinic’s primary focus is to serve the African American population, aged 45 and older, with uncontrolled hypertension
complicated by co-morbid conditions, currently enrolled as SoonerCare Choice Medicaid members, utilizing St.
Anthony Physicians Group North physicians for hypertension therapy management. The Happy Heart Hypertension
Clinic will consist of a physician-led health care team that will include a pharmacist, physician assistant, dietitian,
nurse, and social worker. Patients will have 24-hour access to medical care via access to the online electronic
medical portal EPIC care and via online messaging communication with the pharmacist, social worker, and lead
physician.
Inaccurate blood pressure measurements can stem from biological variability, white coat effect, and
suboptimal technique. The systematic error in underestimating blood pressures by 5mmHg can lead to excluding
individuals who would benefit from hypertension medication therapy.2 The Happy Heart Hypertension Clinic will
emphasize the proper measurement technique per American Heart Association guidelines (see appendix D).
Scope of Service

7

The Happy Heart Hypertension Clinic will implement evidence-based guidelines in order to properly achieve
a patient’s individual blood pressure goals following Joint National Committee 8- 2014 Hypertension
recommendations:
Population
[recommendation]
BP goals
(systolic/diastolic)
Age > 60 yrs [1] <150/<90
Age < 60 yrs [2,3] <140/<90
Diabetes or CKD [4,5] <140/<90
Through an interdisciplinary patient-centered approach, the clinic maintains attention to tailoring therapy to
co-morbid conditions and racial differences that influence blood pressure control: diabetes, renal dysfunction,
obesity, smoking, and African American heritage.
The Happy Heart Hypertension clinic will offer services that cater to lifestyle modifications that are important
in obtaining adequate blood pressure control including: smoking cessation counseling, nutrition education, and diet
planning.
Prior to the patient starting at the Happy Heart Hypertension Clinic, a primary care physician at the St.
Anthony Physicians Group North will have seen them. Patients fitting the at-risk characteristics will be identified
through EMR data analysis and pharmacy claims data. SoonerCare Choice (Medicaid) will also identify at-risk
patients and refer them.

8

Pharmacist’s Role at The Happy Heart Hypertension Clinic
Pharmacists at the clinic will be the leader in optimizing patient-centered hypertension management. The
pharmacist is required to have a valid pharmacist license through the Oklahoma State Board of Pharmacy. The
pharmacist will be Board of Pharmacy Specialties certified in ambulatory care pharmacy (BCACP). The pharmacist
will construct, implement, and encourage use of a hypertension management protocol that follows JNC 8 - 2014
Hypertension recommendations, which will include recommendations for specific medication use and lifestyle
modification implementation that will be adopted by the rest of the healthcare team. (See appendix E for protocol)
The pharmacist will have MTM certification through the American Pharmacists Association (APhA). They will provide a
complete medication therapy management (MTM) service that will consist of the 5 five core elements of MTM:
Medication therapy review, Personal medical record, Medication action plan, Intervention, and Electronic
documentation/follow-up. The MTM service model will integrate PCMH core principles for patient-centered care
through a thorough assessment of patient’s medication-related needs, discovering the patient’s medication
experience, identification of the medication-related problems of inappropriate medications, unsafe medications, and
adherence to medication regimens, development of a care plan following interview of the patient for specific
preferences, and effective evaluation of the patient outcomes through timely coordination of follow-up consultation
with other healthcare providers.3 The Health IT certified (CPHIE) pharmacist will optimize health information
technology exchange for providers and patients.
The pharmacist’s role will be key in interviewing the patient prior to starting at the clinic and during
management for adherence barriers, adverse reactions, inappropriate concomitant drug use, and suboptimal
medication regimens. Through a scope of practice agreement with St. Anthony Physicians Group North, the
pharmacist will be able to modify medication regimens through addition or removal of medications, ordering of
laboratory tests, and monitoring of the patient’s blood pressure control.

9

Description of Services 4
Before meeting with the pharmacist for the initial visit, the patient will complete a medical intake,
hypertension aptitude survey. The 8-question survey will gauge the patient’s global awareness of hypertension as
an illness, knowledge about the importance of exercise and diet in maintaining a normal blood pressure, knowledge
about blood pressure goals, and awareness to the signs and symptoms of stroke and heart attack. The survey will
utilize a 5-point Likert scale (Agree, Strongly Agree, Disagree, Strongly Disagree, Not Sure) to measure the patient’s
hypertension related awareness. (See appendix D for survey) The patient will repeat the survey after 6 months as a
patient of the Happy Heart Hypertension Clinic. The focus of the survey is to measure the increase in aptitude a
patient will have of their disease state. This will be noted as a change in response from: “Disagree” to “Agree” or
“Not Sure” to “Agree” in response to five out of eight questions when comparing baseline surveys to 6-month
progress surveys.
At the initial visit the pharmacist will determine the patient’s understanding of uncontrolled blood
pressure and the consequences. The pharmacist will explain the purpose of the visit and the pharmacist’s role in
their therapy. The pharmacist will then begin the patient interview, using the results of the baseline survey to
navigate the interview. This interview will be formative as an educational session for the patient about hypertension,
what their personal blood pressure goal is and the risks of living with uncontrolled hypertension. This process
incorporates techniques of motivational interviewing through the utilization of the patient’s own goals and will help to
ensure patient compliance in managing their disease state. The educational session will focus on the importance of
the initial lifestyle modification steps and will gauge the patient’s readiness to implement lifestyle changes. The
pharmacist will utilize educational materials from the National Heart, Lung and Blood Institute and provide the
patient with health literacy-cognizant informational leaflets to facilitate the patient’s understanding of the importance
of lowering blood pressure. This visit will help discern what barriers are preventing the patient from obtaining control
of their blood pressure. At this visit the pharmacist can discern if the patient is open to integrating the help of others

10

to allow them to obtain control of their blood pressure. The pharmacist will determine if the patient has financial
challenges that would qualify them as a candidate for financial assistance services from the social worker that is on
staff at the Happy Heart Hypertension Clinic. The patient will also be interviewed to discern what lifestyle habits are
contributing to their current state of uncontrolled blood pressure. At this visit, smoking cessation counseling
services will be mentioned to patients who qualify as a possible service they can utilize in their journey to controlling
their hypertension. Smoking cessation counseling will be offered by the National Tobacco Cessation Collaborative
certified pharmacist, physician assistant, and physician staffed at the clinic. Patients who agree to initiate diet and
exercise changes into their hypertension management regimen will be referred to a dietitian on staff at the clinic.
In order to address medication adherence, initial pharmacist interventions will include the
pharmacist obtaining a first-hand blood pressure reading using the American Heart Association technique for
measuring blood pressure and comparing it values obtained by the triaging nurse. (See appendix D for AHA
technique) The pharmacist will also assess the patient’s ability to self-monitor blood pressure at home and introduce
self-monitoring and use of blood pressure logs. Through probing for the patient’s medication experience, the
pharmacist will tailor adherence interventions to unintentional and intentional medication adherence issues for each
patient. For unintentional medication adherence barriers, the pharmacist will introduce techniques to aid the patient
in remembering to take medications: pill containers, alarm setting, and when possible employ the social support of
caregivers or family. To address intentional medication adherence barriers, the pharmacist will focus on motivational
interviewing and utilize an educational approach to the importance of adherence to anti-hypertensive medications.
Pharmacists are equipped to handle intentional non-adherence stemming from medication side effects and costs of
medications through counseling patients on ways to mitigate medication side effects and employing the aid of the
social worker to address financial reasons for medication non-adherence.
In order to optimize anti-hypertensive medication therapy: the pharmacist will perform a
complete medication history with the patient at the initial visit. The pharmacist will review the current medication
regimen for any medication-related problems which include: suboptimal dosing per protocol, inappropriate

11

medications due to co-morbid conditions, drug-drug interactions with non-antihypertensive medications, and any
adverse drug reactions the patient may be experiencing or is at high risk of the experiencing. Under the scope of
practice agreement, the pharmacist will be able to construct a new medication therapy regimen for the patient and
propose it to the lead physician, modify the patient’s current medication regimen by titration of dosing, or add or
remove medications.
Follow-up Visit:
For uncontrolled blood pressure: The patient will return to the clinic every 4 weeks until blood pressure is
controlled according to guidelines. At the follow-up meetings, the pharmacist will review the patient’s at-home blood
pressure logs when applicable. If needed, the follow-up visit can be completed through telephone if transportation is
an issue for the patient. The pharmacist will complete medication dosage titration at every follow-up to avoid side
effects, with a goal of patient obtaining blood pressure goal in 4 months. If the patient is still uncontrolled, following
medication dosage optimization, the pharmacist may add a medication following clinic protocol.
For controlled blood pressure: the patient will be seen for an in-person follow-up visit at the 6-month point
with the pharmacist. The patient will be contacted via telephone for follow-up at the 3-month point. After the 6-
month in-person follow-up, the patient will be contacted at the 9-month and 12-month mark for follow-up via
telephone communication. At the one-year mark, patients with controlled blood pressure will be referred to their
primary care physician at St. Anthony Physicians Group North.
For all follow-up visits: the pharmacist is held responsible for modifying a patient’s medication regimen under
the actions outlined in the scope of practice agreement. The pharmacist will be responsible for maintaining
communication with the lead physician about patients whose blood pressure is currently uncontrolled using 3 or
more anti-hypertensive medications and recommending seeking a hypertension specialist when applicable. At each
follow-up visit, the pharmacist will reinforce lifestyle modifications, medication adherence techniques and patient’s
social support, through continued education about how each component is vital to controlling blood pressure.

12

Population Within Five-Mile Radius^
Currently there are 69,988 households located within the vicinity of the Happy Heart Hypertension Clinic. The
median household income is lower middle-class at $37,282. The targeted 45-64 year old age population makes up
24.5% and is expected to increase to 26.1% in 2019. The African American population is the second largest and
makes up 28.2% of the area’s total population. Currently, nearly 20% of the population is using diet to control salt
consumption (3.3%), blood sugar level (7.9%) or cholesterol level (8.6%). Of the 32.5% that are using health-
related diet modifications, only 3.2% use a doctor to guide their current diet method. Nearly ¾ of the population
has visited a physician once in the last 12 months. Of the population who has visited a physician in the last 12
months, 5.3% of those visits were to a cardiologist, 5.6% were to an internist and 4.8% to a mid-level practitioner.
In the area, the anti-hypertensive medications make up the largest percentage of prescription drug use (14.3%),
followed by high cholesterol (8.6%). The majority obtains prescriptions from commercial pharmacies or drug stores.
Oklahoma County SoonerCare (Medicaid) Population*
Currently, the black population makes up the second largest population enrolled in SoonerCare in Oklahoma County
(42,998) following the Caucasian population. The 19 – 64 years old enrollees make up the second largest age
population following children 18 years old and younger.
Oklahoma State SoonerCare Choice Population*
There are three predominant delivery systems for SoonerCare in the state of Oklahoma: SoonerCare Traditional,
SoonerPlan, and SoonerCare Choice. Currently, SoonerCare Choice has the largest population of enrollees of the
three delivery systems.
A See Appendix B * See Appendix C
Location Analysis

13

Businesses within 2-mile-Radius+
Currently, OSSO Orthopedic and Sports Medicine, St. Anthony Occupational Health Center, St. Anthony
North Ambulatory Surgery Center, and St. Anthony Community Hospital North are located in the vicinity of the clinic.
Three pharmacy- oriented businesses are located within 2 miles of the Happy Heart Hypertension Clinic: Lee A.
Ross, DPH, Maxcare and Rx Linc Inc. MaxCare is a pharmacy benefits manager. Rx Linc Inc is a health information
technology company. Lee A. Ross DPH is a pharmacy located in the Nichols Hills area that does not offer
hypertension medication therapy management.
+Information provided by Google© Maps

14

Hours of Clinical Operations
The Happy Heart Hypertension clinic will provide services Monday through Thursday, from 8am to 5pm.
Projected Pharmacist-Seen Patient Volume: Year 1
During the first month of operations, the pharmacy service will target a patient volume of 4 patients per every 4-
hour session. Each session per patient will be 1 hour in duration. The projected amount of new patients to be seen
by the end of the first month is 128 patients. The projected new patient population to be seen by the end of a 6-
month period is expected to include all 400 patients St. Anthony Physicians Group North and Medicaid has
recognized to require hypertension management services.
0
20
40
60
80
100
120
140

June

July

August

September

October

November

December

Es=mated
Number
of
New
Pa=ents
Reached

in
First
6
months

Number
of
PaSents

Details of Clinic Operation

15

Projected Staff Involvement

In the first year of the Happy Heart Hypertension Clinic opening, the facility will possess full-time employment of
the St. Anthony’s Administrative Director of Practice Operations, the clinic’s chief operating officer, a lead physician,
a physician assistant, a pharmacist, a social worker, a dietitian, a nurse and front desk manager.
In the third year of the Happy Heart Hypertension Clinic operations, the facility will transition to maintaining as
needed and/or part-time employment of the St. Anthony’s Administrative Director, the clinic’s chief operating officer,
and lead physician. It is projected that clinic’s physician assistant will overtake the physician responsibilities for each
established patient’s follow-up visits. A second nurse will be employed on an as needed and/or part-time basis.
In the fourth year of the Happy Heart Hypertension clinic operations, the facility will begin part-time and/or as
needed employment of a social worker and second qualified pharmacist.

2014
2015
2016
2017
2018
2019

St.
Anthony’s

Admin.
Director

Physician
(COO)

Lead
Physician

Physician

Assistant

Pharmacist
1

Pharmacist
2

Social
Worker

Dietitian

Nurse
1

Nurse
2

Front
Desk

Manager

Full-‐
time

Not
hired

As
needed

Projected Clinic operations

16

Projected Staff Involvement (Cont’d)

Front
desk

manager

St.
Anthony's
Hospital:
AdminstraSve

Director
of
PracSce
OperaSons

Physician:
Chief
operaSng
oﬃcer

1
Lead
Physician

1-‐2
Nurses
1-‐2
Pharmacist
1
Physician
Assistant
1
Social
worker
1
DieSSan

1
Payroll

Coordinator

1Billing

Coordinator

17

Standards of Care

The Happy Heart Hypertension Clinic will manage patients utilizing Joint National Committee 8- 2014 Hypertension
recommendations to guide tailoring of individual patients’ medication therapy regimens and provider interventions. A
pharmacist-constructed protocol for medication management based off evidence- based guidelines will exist as the
standard for patient-centered hypertension management to reach population goals of service. (See appendix E)
The Happy Heart Hypertension Clinic will uphold the National Committee for Quality Assurance standards for
recognition as a level 2 Patient-Centered Medical Home. (See appendix A).
Assessment of impact
The Happy Heart Hypertension Clinic will sustain ongoing progress to obtaining service goals through our
continuous quality improvement initiatives. (See page 20 for more information)
At the 6-month mark, an EHR data analysis will be completed to assess the patient population for patients who are
at goal blood pressure (<140/<90 mmHg), and who have reached ≥
80% adherence to their medication
regimens.
Assessment of the service’s impact on the health literacy of the patient population will be obtained at the 6-month
mark through patient completion of the Hypertension Aptitude survey. The targeted impact is an increase in Likert
scale response greater than or equal to 4 or response of “Agree” or “Strongly Agree.”

Impact of Service

18

St. Anthony Physicians Group North
Our services will be marketed to the physicians primarily by word of mouth and use of fliers. The physician meetings
will take place during staff meetings or one-on-one in individual sessions. Patient progress will be tracked and
reported to the physicians in order to show the efficacy of the medical home. Fliers will be made and distributed to
nearby hospital staff and cardiology units so that all members of the healthcare team as well as patients will be
made aware of our services.
Future Staff Members
Our services will be featured in St. Anthony’s new employee orientation to make staff members aware of the medical
home. We will work with local health professional training programs to allow their students and faculty to see our
clinic in order to promote our services and show the benefit of interdisciplinary collaboration in a clinical setting.

Marketing Plan

19

Epic Care electronic Medical Record5

The Happy Heart Hypertension Clinic will adopt the Epic Care EMR currently being used by the St. Anthony
Physicians Group North. In utilizing the same EMR as all St. Anthony’s facilities, this will allow continuity of care and
will help to limit any barriers that might interfere with transitions of care. The structure of Epic Care EMR system
allows St. Anthony’s to share clinical data while keeping this information separate from scheduling and financial
information. Epic meets the “Meaningful Use” standards for CMS and has received a level two certification for EMR
technology.
CMS “Meaningful Use” is designed to improve quality, safety, and better clinical outcomes for patients. CMS
incentives can only be obtained for hospitals that obtain 14 core objectives, 5 out of 10 from menu set objectives,
and 15 clinical quality measures. Our clinic, in conjunction with the Epic EMR, meets these criteria and qualifies for
incentive payments.
The pharmacist will utilize Epic Care EMR to document interactions with patients in the format of the
abbreviated SOAP note. The EMR will document the MTM sessions, medication histories, and modifications to
medication regimens provided by the pharmacist. The contents of the electronic documentation will include an
abbreviated SOAP note template, separating the subjective and objective information and the pharmacist-provided
assessment and plan for therapies. The lead physician, dietitian, social worker and nurse will have individual access
codes to utilize the Epic Care EMR portal. Through interdisciplinary access to the EMR, bi-directional and
collaborative clinical information exchange is possible at the Happy Heart Hypertension Clinic to optimize patient
outcomes. Interoperability of Epic Care EMR health information exchange is highlighted through its fulfillment of
Certified EHR Technology for Meaningful Use.
Documentation

20

The financial billing component of Epic Care EMR has an incoming and outgoing billing capability. The HLv2
interface facilitates the routing of incoming charges through rules-based routing resulting in the crediting to the
appropriate account for billing. The HLv2 interface can also be used to send charges to an external billing system.
Epic Care has a substantial contact management system that helps track detailed expected reimbursement for
claims and detection of variances. Epic Care has the capability of configuring the contact management systems of
third parties. Epic Care provides support for credit cards to be used to pay copays, inpatient and outpatient bills and
medications. This integration is facilitated through the patient portal, patient kiosk software, over-the-phone and
billing offices. Cash reconciliation is supported through Epic Care acceptance of incoming bank deposit information.
Patient third-party eligibility can be determined and verified through a bi-directional real-time query system.
Patient 24-hour connectivity is established through Lucy, Epic’s personal, portable health record. Epic Care EMR
provides patients with a Direct Address they can use to send themselves copies of their medical information using a
Certified Electronic Health Record Technology. Any patient portal that supports “View, Download and Transmit” can
install Lucy. Epic Care’s “Content Linking” allows the patient’s view of their medical chart to be supplemented with
educational materials that are specific to their problems, medications and other aspects of treatment. The patient
portal also provides self-service features including messaging with providers and appointment scheduling.
Epic Care EMR has the ability to integrate with state, federal and professional registries to track public
health. It fulfills the Meaningful Use optional objective 2 to send reportable lab results to public health agencies,
including immunization data, birth certification, and cancer registry information.

21

Pharmacists Mutual Companies will provide the individual pharmacist professional liability policy for
the pharmacists on staff at the Happy Heart Hypertension Clinic. The policy will protect the pharmacist with limits of
$1,000,000 for each occurrence and $3,000,000 aggregate, 24 hours a day, for a claim that occurs within the U.S.,
its territories and possessions, Canada or Puerto Rico. Pharmacists Mutual Companies will also provide pharmacy
professional liability insurance for the Happy Heart Hypertension Clinic with limits up to $5,000,000 per occurrence
and $5,000,000 aggregate. 6
The policies will cover pharmacist services provided at the Happy Heart Hypertension Clinic:
• Participation in drug and device selection, including prescribing by protocol, agreement or collaborative
practice
• Administration of drugs, including immunizations
• Drug regimen reviews
• Medication consulting and patient counseling which are related to drugs, medical devices or medical
conditions
• Maintenance of proper records for drugs and devices
• Pharmaceutical care and other services of a professional nature legally performed by a registered
pharmacist
The individual professional liability policy will also cover:
• Loss of wage or salary not exceeding $20,000 total
• Up to $10,000 reimbursement of attorney fees for representation at the Board of Pharmacy
Liability

22

Continuous Quality Improvement

The Happy Heart Hypertension Clinic will have a team of providers dedicated to continuous quality improvement. The
team will be made up of the Chief Operating Officer (COO) Physician from St. Anthony Physicians Group North,
pharmacist, nurse and a St. Anthony’s human resources representative. The team will meet monthly to discuss
current quality and performance initiatives that will be established prior to the clinic opening.
There are 5 areas of continuous quality improvement that the clinic will focus on:
1. Inaccuracy of blood pressure measurement: This can manifests from biological variability of
patients, but can be due to suboptimal technique of the provider who is measuring the blood pressure or
“the white coat effect.”+ The systematic error of underestimating true blood pressure by 5 mmHg results in
the exclusion of patients who would benefit from anti-hypertensive interventions. 1
a. Specific Goal: Assessment of blood pressure measurement technique required for nurse,
pharmacist, and physician assistant every 6 months.
b. Measurement: Utilizing American Heart Association (See appendix D) guidelines for training and
competency assessment. The individual being assessed must complete the assessment with
100% accuracy as determined by the COO physician at the 6-month mark.
2. Obtaining blood pressure goals: 100% of the patients utilizing the Happy Heart Hypertension Clinic
will not be at blood pressure goal as defined by JNC 8- 2014 Hypertension guidelines.
a. Specific Goal: 65% of the patient population to be at blood pressure goal (< 140/<90mmHg)
at the 6-month mark of using the service.
b. Measurement: Follow-up with patients with uncontrolled blood pressure every 4 weeks per
protocol with appropriate EMR documentation of measured blood pressure, dosage titration and

23

medication regimen modifications. At the 6-month mark, conduct measurement the patient’s blood
pressure using American Heart Association technique.
3. Physician compliance to JNC 8-2014 hypertension guidelines:
a. Specific Goal: 75% of black patients with uncontrolled hypertension will be on a thiazide
diuretic or calcium channel blocker per protocol at the 6-month mark.
b. Measurement: EMR database analysis of patient records to assess if 75% of black population
has a thiazide or calcium channel blocker included in their medication regimen.
4. Patient Satisfaction: As a newly established practice, we believe it is important to gauge patient
satisfaction with our hypertension clinic after using our services. (See Appendix F)
a. Specific Goal: We aim to have a score of 4 or greater on all questions on the patient feedback
graphic rating scale survey at the 6-month mark.
b. Measurement: Patients will complete an identical survey at the 3- month and 6-month mark of
attending clinic.
5. Measuring the Pharmacist’s Impact: We would like to measure the impact of the presence of the
pharmacist on a health care team in a Patient-Centered Medical Home practice model. (See Appendix F)
a. Specific Goal: We aim to have a score of 4 or greater on all questions on the staff feedback
graphic rating scale survey at the 6-month mark.
b. Measurement: The staff feedback survey will be distributed to the nurse, physician assistant,
physician, social worker and dietitian at the 6- month mark of the clinic opening.
Outcomes of Continuous Quality Improvement: Our goal is to quantitatively increase the number of
patients with controlled blood pressure, increase compliance to guidelines and evidence-based protocols to optimize
patient-centered care and increase patient and provider satisfaction.
* See Appendix D ; + See Appendix D for definition

24

Scope
of
Practice

for

[Pharmacist],
Pharm.D.,
BCPS,
BCPS-‐AQ
Cardiology

With
respect
to
clinical
services
within
the
Happy
Heart
Hypertension
Clinic,
in
association
with
the
physicians
in

St.
Anthony’s
Hospital,
Department
of
St.
Anthony
Medical
Associates,
[Pharmacist]
is
authorized
to
perform
any

of
the
following
activities:

1. Assess
the
effect
of
and
make
recommendations
on
the
drug
therapy
of
a
patient.
Patients
may
be

referred
to
[Pharmacist]
for
formal
consultation
on
their
pharmacotherapy
regimens.
All
consultations

and
visits
may
be
documented
in
the
patient’s
chart.

2. At
any
given
referred
patient
visit,
[Pharmacist]
is
authorized
to
assess
the
patient’s
blood
pressure

control,
obtain
medical
and
medication
histories,
and
provide
education
to
increase
patient
adherence

with
their
prescribed
drug
regimens.
Further,
[Pharmacist]
can
develop,
in
conjunction
with
the
primary

care
practitioner
or
supervising
physician,
therapeutic
plans
to
help
improve
care
for
those
patients
with

complicated
medical
conditions,
pharmacotherapeutic
regimens,
or
patient
compliance
issues.

[Pharmacist]
can
modify
dosing
or
administration
of
an
existing
drug
therapy
regimen
or
implement
a

new
drug
therapy
regimen
with
supervising
physician
review.

3. [Pharmacist]
may
perform
limited
physical
examinations
to
assess
the
response
to
prescribed
drug

therapies.
Clinical
laboratory
parameters
may
be
obtained
and
ordered
as
needed
for
patient
care.

4. [Pharmacist]
may
phone
in
prescriptions
to
pharmacies
for
medications
used
for
the
consulted
disease(s)

that
the
patient
is
currently
taking
or
for
modifications
or
additions
to
therapy
authorized
in
the

consultation
per
the
available
referral
form.

5. For
any
given
pharmacotherapy
visit,
in
which
case
the
patient
is
not
being
evaluated
by
the
physician
on

the
same
day
in
accordance
with
billing
guidelines,
[Pharmacist]
may
bill
for
a
Level
I
visit
(99211)
to
the

patient’s
insurance.
In
addition
each
visit
will
bill
under
APC
codes
600-‐602
depending
upon
complexity.

The
chair
of
St.
Anthony
Medical
Associates
will
determine
how
claims
collected
for
pharmacy
services

will
be
collected
and
distributed.

Where
appropriate,
all
work
will
be
supervised
by
available
physicians
and/or
physician
assistant
in
the
clinic

where
[Pharmacist]
is
practicing.

________________________________

__________________________________

[Pharmacist],
Pharm.D.,
BCPS-‐Cardiology

[Collaborating
physician],
MD.

________________________________

__________________________________

Date

Date

25

Point of Care Devices
Device and Components
Pharmacy Service* Physician Services#
Cost
Omron Automatic Blood Pressure Monitor 7 Series* 4 x $179.79
Omron Small Adult Cuff* 2 x $40.27
Omrom Standard Adult Cuff* 6 x $40.27
Omrom Large Adult Cuff* 2 x $40.27
Welch Allyn Mobile Blood Pressure Unit* 1 x $820.28
Welch Allyn Child Cuff* 2 x $43.97
Welch Allyn Adult Cuff* 2 x $43.97
Welch Allyn Large Adult Cuff* 2 x $43.97
Cholestech LDX machine# 1 x $1800
Hemocue Glucose machine# 1 x $649.43
Supplies
Description of Supplies for Physician Clinic Cost
Cholestech LDX cartridges – Lipid Profile (10 per box) 4 x $108.69
Cholestech capillary plunger (50 per vial) 2 x $7.91
Cholestech capillary tubes (50 per vial) 2 x $20.98
Hemocue Glucose 201 cuvettes (4 vials of 25 per box) 1 x $276.67
Glucotrol – AQ HI/LO CTL LIQ – Hemocue control solution 1 x $50.07
CoaguCheck Lancets SAF (200 per box) 5 x $60.88
Alcohol pads (200 per box) 5 x $2.07
Bandages (100 per box) 5 x $2.25
2x2 Gauze (200 per box) 6 x $2.60
Gloves—small (pwd free) (100 per box) 5 x $7.25
Gloves—medium (pwd free) (100 per box) 5 x $6.97
Gloves—large (pwd free) (100 per box) 5 x $7.10
Gloves—small (latex and pwd free) (200 per box) 1 x $12.08
Gloves—medium (latex and pwd free) (200 per box) 1 x $12.08
Gloves—large (latex and pwd free) (200 per box) 1 x $12.08
Capillary tube with bulb (100 tubes/30 bulbs per box) 3 x $45.01
Sharps Containers (5.4Q CLR WALL) (10 per box) 1 x $5.22
Clorox Hydrogen Peroxide Cleaner (Disinfectant) 2 x $6.07
WIP CLOROX GERMICIDAL 70/EA 2 x $21.07
Bleach (liquid) 1 x $3.50
Certification Costs (pharmacist and service as a whole)
Description of certification Cost
National Committee Quality Assurance Level III application (pharmacy) $500
APhA Medication Therapy Management (MTM) certification $255
Board Certified Ambulatory Care Pharmacist $600 initial fee; $400 recertification
(7 year renewal)
Health Information Exchange $1300; recertification biannual fee $100
Tobacco Treatment Specialist Certification $1000 for course
Financial Plan:

26

Billing 7
The St. Anthony Physicians Group North PCMH is defined as hospital ground, which allows our hypertension
clinic to fully take advantage of facility fee codes. Our billing documentation will include the 99211 code as well as a
facility revenue code. The facility fee code is part of the Ambulatory Payment Classification (APC). These claims will
be submitted under Medicare part B and will provide standardized outpatient compensation. The APC codes are
independent of provider fees. The commonly used fee levels are 1-3 (codes 600-602). Each level is more complex
and has higher compensation rates approaching level 3. Medicare standardizes compensation rate and typically
pays out at 100% of the APC billing rate. Our claims will be submitted with specific information in order to insure full
reimbursement, including: medical history review, reason for visit, medication profile, drug therapy recommendation,
and anticipated adherence to therapy.
We will be utilizing the CPT billing codes 99211-99215 (level I-IV) in order to bill private insurance plans
as well as Medicare Part B. For this “incident to” billing, pharmacists are providing the consultations. The billing will
primarily be restricted to the level I billing.
MTM codes will be used to charge for MTM sessions provided to patients who qualify for such services. The
codes utilized will range from 99605-99607. The 99605 code is for the initial new patient (15min), 99606 code is
for the initial returning patient (15min), and 99607 code is for each extra 15min with the pharmacist.

Financial Plan (cont’d)

27

Daniel Trobare

819 East Dr. Apt A lOklahoma City, OK 73105 l 405-503-8437l dtrobare@ouhsc.edu

Education

PGY2 Ambulatory Care Pharmacy Residency
University of Washington
Seattle, Washington
June 2014
PGY1 Pharmacy Practice Residency
University of Washington
Seattle, Washington
June 2013
Doctor of Pharmacy
Ambulatory Care Specialty Track
University of Oklahoma College of Pharmacy
Oklahoma City, OK
June 2012
Biochemistry
&
Molecular
Biology
B.S.

Microbiology
Minor

Oklahoma State University
Stillwater, OK
May 2008
Board
of
Pharmacy
Specialties
Certifications

Ø Ambulatory
Care
Pharmacy
July 2014

Miscellaneous

Ø Health
Information
Exchange
Certification

June 2014
Ø Tobacco
Cessation
Specialist
September 2012
Licensure

CPR/BLS Certified
Pharmacy Intern, License# I-8725
Blood-Born Pathogen Training

Fall 2014 - Present
Fall 2012 - Present
Fall 2012 - Present
Awards
and
Recognition

Ø OSHP
Community
Service
Recognition
August 2013
Ø ACCP
Distinguished
Lecturer:
Barriers
to
Diabetic
Eye
Care
September 2013
Curriculum Vitae

28

Appendix A:
The American Academy of Pediatrics, American Academy of Family Physicians, American College of Physicians and
the American Osteopathic Association jointly support the Patient- Centered Medical Home model.
National recognition as a PCMH is possible through: National Committee for Quality Assurance, Joint Commission,
and the Accreditation Association of Ambulatory Health Care.
1. PCMH Eligibility. NCQA Measuring Quality Improving Health Care.
http://www.ncqa.org/Programs/Recognition/Practices/PatientCenteredMedicalHomePCMH/BeforeLearnItPCMH/PCMHEligibilit
y.aspx. Accessed September 5,2014
2. Defining PCMH. AHRQ Agency for Health Research and Quality. http://pcmh.ahrq.gov/page/defining-pcmh. Accessed
September 5, 2014
The AHRQ (Agency for Healthcare Research and Quality) defines this primary care model using 5 core principles: 2
Ø Comprehensive Care: Patient’s physical and mental health needs, including prevention and wellness, acute care,
chronic care. Healthcare provider team includes pharmacists, nurses, physician associates, nutritionists, social
workers and others.
Ø Patient Centered Care: Strong emphasis on whole person care that revolves around awareness of patients’
preferences, culture and values. This model adapts to a level of care that the patient choose.
Ø Integrated Team-based Care: Coordination of care across the whole health system to include specialty clinics,
hospitals, home health settings and community clinics which is vital to proper transitions of care.
Ø Accessible Services: Options of enhanced in-office hours, email communication, anytime-telephone access, and same-
day urgent visits accommodate patient preference to medical access.
Ø Quality and Safety: Through clinical decision support tools, evidence-based medicine, patient involvement and
feedback of therapy outcomes and satisfaction, commitment to continuous quality improvement and safety data
reporting.

The Patient-Centered Medical Home (PCMH) is an ambulatory care model of primary care practice that provides, first
contact, continuous, comprehensive, whole person care for patients across an integrated health system.1
Each patient has a primary care physician leading a team of healthcare professionals to develop therapeutic
regimens specifically tailored to the patient’s needs and preferences. 1

29

Appendix A (cont’d):
National Committee for Quality Assurance has established 3 levels in which healthcare practices may be recognized
as a Patient-Centered Medical Home.
Recognition level: Required Points: Must pass elements
Level 1 35 to 59 points Ø 6 to 8 elements are
required for each level
Ø Score each must-pass
element must be greater
than or = 50%
Level 2 60 to 84 points
Level 3 85 to 100 points
1. PCMH Eligibility. NCQA Measuring Quality Improving Health Care.
http://www.ncqa.org/Programs/Recognition/Practices/PatientCenteredMedicalHomePCMH/BeforeLearnItPCMH/P
CMHEligibility.aspx. Accessed September 5,2014

30

Appendix b:
Location Analysis – Population within a 5-mile radius1
Summary 2014 2019
Population 157,999 167,986
Households 69,988 74,529
Families 35,181 37,030
Median Household Income $37,282 $43,401
Per Capita Income $25,576 $30,311
Population by Age 2014 2019
0-4 10,656 6.7% 11,364 6.8%
5-9 9,877 6.3% 10.092 6.0%
10-14 8,605 5.4% 9,599 5.7%
15-19 8,717 5.5% 9,391 5.6%
20-24 11,761 7.4% 11,684 6.9%
25-34 28,179 17.8% 27,457 16.3%
35-44 20,018 12.7% 22,654 13.5%
45-54 19,455 12.3% 19,801 11.4%
55-64 19,176 12.1% 20,325 12.1%
65-74 12,040 7.6% 15,287 9.1%
75-84 6,382 4.0% 7,762 4.6%
85 + 3.135 2.0% 3,390 2.0%
Race and Ethnicity 2014 2019
White 81,815 51.8% 83,585 49.8%
Black 44,495 28.2% 46,841 27.9%
American Indian 4,766 3.0% 5,046 3.0%
Asian 5,857 3.7% 6,333 3.8%
Pacific Islander 159 0.1% 166 0.1%
Hispanic Origin 21,765 13.8% 27,768 16.5%
Population Health Diet
Cognizance
2014
Diet Control for salt restriction 4,602 3.3%
Diet Control for blood sugar
level
9,770 7.9%
Diet control for cholesterol level 10,658 8.6%
Diet Control for weight loss 15,764 12.7%
Used Doctor’s care for diet
method
4,028 3.2%
1. Information provided by the Greater Oklahoma City Chamber

31

Appendix B (cont’d):
Location Analysis - Population within 5- mile Radius1
Healthcare visits 2014
Visited doctor in last 12 months:
1 time
90,612 73.1%
1- 2 times
29,330 23.7%
3- 5 times
26,796 21.6%
Visited cardiologist in last 12 months 6,542 5.3%
Visited internist in last 12 months 6,986 5.6%
Visited nurse practitioner in last 12
months
5,936 4.8%
Prescription drug use: 2014
Depression 8,691 7.0%
Diabetes (insulin dependent) 2,776 2.2%
Diabetes (non-insulin dependent) 4,610 3.7%
High blood pressure 17,754 14.3%
High cholesterol 10,645 8.6%
Location of prescription
purchases:
2014
Discount/department store 5,397 4.4%
Drug store/pharmacy 44,271 35.7%
Supermarket 9,370 7.6%
Mail order 9,314 7.5%
1. Information provided by the Greater Oklahoma City Chamber

32

Appendix C:
Oklahoma County SoonerCare (Medicaid) Population1
Race 2014
American Indian 6,287
Asian or Pacific Islander 4,345
Black or African American 42,998
Caucasian 97,437
Hispanic 49,456
Total Population covered by Medicaid 27.92%
Statewide Rank for Medicaid Members 1
Age
Adults Age 19 - 64 44, 513
Adults Age 65+ 9,763
Children Age 18 and under 113,760
Delivery System of Total Medicaid Enrollment Population (%)
SoonerCare Traditional 236,575 (29%)
SoonerPlan 41,943 (5%)
SoonerCare Choice 540,592 (66%)
Oklahoma State SoonerCare Choice Population1
1. Statistics and Data. Oklahoma Health Care Authority. http://www.okhca.org/research.aspx?id=87&parts=7447.
Updated November 10, 2014. Accessed November 16, 2014
Race
Breakdown
of
SoonerCare
Choice

Enrollment:
September
2014

American
Indian,
11%

Asian/Paciﬁc
Islander,
2%

Black
/African
American,12%

Caucasian,
63%

MulSple
Race,
9%

Declined
to
Answer,
3%

33

Appendix D:
1. Nemerovski C, Young M, Mariani N, Bugdalski-Stutrud C, Moser L. Project ImPact: Hypertension outcomes of a
pharmacist-provided hypertension service. Innovations in pharmacy. 2013; 4(3):126.
Hypertension Aptitude Survey

Please Circle the number that best describes your response.
1= Strongly Disagree 2= Disagree 3= Neither Agree or Disagree
4= Agree 5= Strongly Agree
1. My overall health is good
1

2

3

4

5

2. Overall, it is important to take my blood pressure medications.
1

2

3

4

5

3. I feel well informed about my diagnosis of high blood pressure.
1

2

3

4

5

4. A healthy diet and exercise are necessary in managing my high blood pressure
1

2

3

4

5

5. I know my blood pressure goals.
1

2

3

4

5

6. I know the signs and symptoms of a stroke.
1

2

3

4

5

7. I know the signs and symptoms of a heart attack.
1

2

3

4

5
8. I know what to do if I experience the signs or symptoms of a stroke or heart attack.
1

2

3

4

5

34

Appendix D (Cont’d):
American Heart Association Recommended Technique for measuring blood pressure: 1
• Patient positioning:
o Seated with their arm resting on a table at heart level or supported by hand of provider
o Quiet relaxed setting
o Not immediately following caffeine, smoking or exercise
o No talking
o Legs should be uncrossed and sitting on the floor
o Patient’s back is supported on the chair
o Repeat reading after 5 min of rest
• Size of cuff and placement:
o Awareness of cuff sizes: adult large, medium, small
o Two finger widths of tightness
o On bare skin
o Locate and palpate the brachial pulse
• Taking the digital reading of Blood Pressure
o Record Blood Pressure
o Record Time and Date
Definition of White Coat Effect: 2 defined as blood pressure levels that are the 95th percentile or higher when
measured in a physician’s office or clinic but are completely normal (average blood pressure is < 90th percentile)
outside of clinical setting.
1. Pickering TG, et al. Recommendations for blood pressure measurements in humans and experimental animals:
Part 1: Blood pressure measurement in humans: Hypertension. 2005(45): 142- 61
2. Urbina E. Alpert B, Flynn J., et al. Ambulatory Blood Pressure Monitoring in Children and Adolescents:
Recommendations for Standard Assessment: A Scientific Statement From the American Heart Association
Atherosclerosis, Hypertension, and Obesity in Youth Committee of the Council on Cardiovascular Disease in the
Young and the Council for High Blood Pressure Research. Hypertension. 2008; (52): 433-451.

35

APPENDIX E:
1. National Heart, Lung and Blood Institute, National Institutes of Health. The Seventh Report of the Joint National Committee on Prevention,
Detection, Evaluation and Treatment of High Blood Pressure – Complete Report. National Heart, Lung, and Blood Institute, National
Institutes of Health. NIH Publication No. 04-5230, 2004.
2. James PA, Oparil S, Carter B, et al. 2014 Evidence-Based Guideline for Management of High Blood Pressure in Adults: Report from the
Panel Members Appointed to the Eight JNC.JAMA. 2014. 311(5); 507-520. doi:10.1001/jama. 2013.284427

36

Appendix F:
Patient
Feedback
Survey:
Pharmacy
Services

Please
Circle
the
number
that
best
describes
your
response.

1=
Strongly
Disagree

2=
Disagree

3=
Neither
Agree
or
Disagree

4=
Agree

5=
Strongly
Agree

Pharmacist
spoke
about
hypertension
in
a
language
I
could

understand

1

2

3

4

5

I
trust
that
the
pharmacist
is
performing
to
the
best
of
their
abilities
to

treat
my
hypertension.

1

2

3

4

5

Pharmacist
gave
me
options
to
save
money
on
hypertension
therapy

1

2

3

4

5

I
felt
comfortable
openly
talking
with
pharmacist
about
my

hypertension
and
medication
therapy

1

2

3

4

5

The
pharmacist
told
me
of
the
side
effects
of
my
medications
and
how

I
can
prevent
them

1

2

3

4

5

The
pharmacist
made
me
feel
like
a
was
a
part
of
the
team
in
when

making
decisions
about
medication
therapy

1

2

3

4

5

I
know
that
my
opinions
and
suggestions
were
considered
when

deciding
my
medication
therapy

1

2

3

4

5

1. Pharmacy Management: Essentials for All Practice Settings, 3rd edition. Desselle SP, Zgarrick DP, and
Alston G, eds. New York: McGraw-Hill; 2012. ISBN: 177431-4

37

Appendix F: cont’d
Measuring
Pharmacist’s
Impact
on
Collaboration

1=
unsatisfactory;
2=
below
expectations;
3=
satisfactory;
4=
above
average;
5=
Outstanding

Pharmacist
offers
constructive
criticism,

while
reinforcing
and
demonstrating

appreciation
for
team
members
effort
and

contributions

1

2
3
4
5

Pharmacist
reinforces
good
work
and

demonstrates
appreciation
for
team

members’
efforts
and
contribution.

1
2
3
4
5

Pharmacist
treats
staff
members
with

respect

1
2
3
4
5

Pharmacist
assists
in
coming
to
resolutions

when
problems
arise,
but
does
not
solve

problems
for
the
group
or
engage
in
control

behavior
if
unnecessary.

1
2
3
4
5

Pharmacist
encourages
and
maintains
open

and
frequent
communication
between
staff

members

1
2
3
4
5

Pharmacist
leads
the
environment
with

clear
operating
procedures
for
decision-‐
making,
communication
and
accountability

of
the
staff

1
2
3
4
5

Pharmacist
inspires
commitment
and
action

of
the
staff
members
to
the
goals
of

pharmacy
as
a
whole.
(prescription
count,

number
of
immunizations
per
weeks,

counseling
sessions)

1
2
3
4
5

Pharmacist
actively
pursues
involvement

from
each
staff
member,
highlighting
their

strengths
for
achievable
goals

1
2
3
4
5

Pharmacist
encourages
acknowledgement

or
celebration
of
individual
staff
members

attaining
the
achievable
goals

1
2
3
4
5

Pharmacist
shows
commitment
to
meeting

the
needs
of
all
staff
members
1
2
3
4
5

Pharmacist
is
an
active
listener
and

mediator
when
resolving
conflict
of
interest

or
goals
between
staff
members.

1
2
3
4
5

1. Pharmacy Management: Essentials for All Practice Settings, 3rd edition. Desselle SP, Zgarrick DP, and
Alston G, eds. New York: McGraw-Hill; 2012. ISBN: 177431-4

38

References:
1. Heart Disease in Oklahoma. OSDH. http://www.ok.gov/health/Disease,_Prevention,_Preparedness/
Chronic_Disease_Service/Heart_Disease_and_Stroke/. Accessed November 12, 2014.
2. Jones DW, Appel LJ, Sheps SG, Roccella EJ, Lenfant C. Measuring Blood Pressure Accurately: New and Persistent
Challenges.JAMA. 2003;289(8):1027-1030. doi:10.1001/jama.289.8.1027
3. Patient Centered Primary Care Collaborative. Comprehensive Medication Management Services. Patient Centered Medical
Home: Integrating Medication Management to Optimize Patient Outcomes. 2nd Edition. 2012: 6-7
4. Doucet WR, Veach SR, Egerton S. Physician/Pharmacist Collaboration to Improve Blood Pressure Control – A Guide for
Physicians and Pharmacists. http://www.astho.org/Programs/Prevention/Chronic-Disease/Million-Hearts/Iowa/Protocols-
Algorithms/. Accessed November 16, 2014.
5. Epic Systems Corporation. EPIC website. http://www.epic.com/software-ambulatory.php. Accessed November 25, 2014.
6. Pharmacy Professional Liability. Pharmacists Mutual Companies. http://www.phmic.com/IC/ProfLiab/Pages/PharmLiab.aspx
Accessed November 30, 2014.
7. Haines ST, Haines SL. Ambulatory Care Pharmacy Practice (Chapter 103). In: Remington The Science and Practice of
Pharmacy. 22nd edition. Pharmaceutical Press; 2013: 2525-2538

Written Proposal Happy Heart Hypertension Clinic

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Viewers also liked

Viewers also liked (8)

Similar to Written Proposal Happy Heart Hypertension Clinic

Similar to Written Proposal Happy Heart Hypertension Clinic (20)

Written Proposal Happy Heart Hypertension Clinic