{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T22:18:51Z","timestamp":1790806731139,"version":"4.1.0"},"reference-count":18,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2023,8,18]],"date-time":"2023-08-18T00:00:00Z","timestamp":1692316800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Pharmacy Practice"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:p>Background: Clinical pharmacy services improve several patient chronic disease outcomes. This review evaluates a pharmacist-led chronic care management (CCM) program partnered with a health system for patient outcomes and sustainability. Methods: A mixed methods evaluation based on the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework was completed. Patient A1c and blood pressure readings were retrospectively collected from the electronic health record from August 2018-April 2022. Patients that completed &gt;4 CCM visits with a diagnosis of diabetes and\/or hypertension were included. Results: 557 patients enrolled, 53 had uncontrolled systolic blood pressure (SBP), SBP &gt;130\u00a0mmHg. Average SBP at baseline was 141.0\u00a0mmHg and average SBP at 6\u00a0months was 130.2\u00a0mmHg, ( P &lt; .001). 76 patients had uncontrolled diabetes, A1c &gt; 7%. Average A1c at baseline = 9.1% and average A1c at 6\u00a0months = 8.3%, ( P &lt; .001). 4464 CCM visits with 247 disease-state targeted patients were completed over 44-month with a 100% adoption rate across clinic locations. Implementation facilitators included patient medication cost concerns, disease burden, provider revenue generation, CCM dedicated software, streamlined call process, and remote EMR access. Implementation barriers included provider discomfort \u201cselling the program,\u201d potential patient costs, unclear need from patient, pharmacists not considered providers, pharmacist cost, multi-platform software, reprioritized stakeholder support, and lack of partner site diversification. Program maintenance showed revenue generation was $5925.31-$8879.89 from August 2021-May 2022 and profitability was $3385.61-$1614.23. Conclusion: This study provides lessons learned, strategies for implementation, and ideas for process efficiencies leading to maintenance of a telehealth pharmacist-led CCM service.<\/jats:p>","DOI":"10.1177\/08971900231196624","type":"journal-article","created":{"date-parts":[[2023,8,18]],"date-time":"2023-08-18T19:55:56Z","timestamp":1692388556000},"page":"933-939","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":7,"title":["Evaluation of a Telehealth-Based Pharmacist Led Chronic Care Management Program"],"prefix":"10.1177","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-5154-1426","authenticated-orcid":false,"given":"Ashley","family":"Dohrn","sequence":"first","affiliation":[{"name":"The University of Iowa College of Pharmacy, Iowa City, IA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Hoskins","sequence":"additional","affiliation":[{"name":"The University of Iowa College of Pharmacy, Iowa City, IA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Collier","sequence":"additional","affiliation":[{"name":"The University of Iowa College of Pharmacy, Iowa City, IA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Korey","family":"Kennelty","sequence":"additional","affiliation":[{"name":"The University of Iowa College of Pharmacy, Iowa City, IA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,8,18]]},"reference":[{"key":"bibr1-08971900231196624","doi-asserted-by":"publisher","DOI":"10.2146\/ajhp170789"},{"key":"bibr2-08971900231196624","doi-asserted-by":"publisher","DOI":"10.1002\/pmrj.12127"},{"key":"bibr3-08971900231196624","doi-asserted-by":"publisher","DOI":"10.1177\/1060028018807398"},{"key":"bibr4-08971900231196624","unstructured":"Chronic Care Management Services. Medicare learning network booklet, 2022. MLN909188. https:\/\/www.cms.gov\/outreach-and-education\/medicare-learning-network-mln\/mlnproducts\/downloads\/chroniccaremanagement.pdf"},{"key":"bibr5-08971900231196624","unstructured":"Center for Medicare & Medicaid Services. Frequently asked questions about billing Medicare for chronic care management services. 2016. https:\/\/www.cms.gov\/medicare\/medicare-fee-for-service-payment\/hospitaloutpatientpps\/downloads\/payment-chronic-care-management-services-faqs.pdf"},{"key":"bibr6-08971900231196624","unstructured":"Wilcox-Lee C. 2022 chronic care management cpt codes: Cheat sheet, 2022. https:\/\/www.healthrecoverysolutions.com\/blog\/2022-chronic-care-management-cpt-codes-cheat-sheet"},{"key":"bibr7-08971900231196624","unstructured":"mTelehealth. 2022. https:\/\/mtelehealth.com\/cms-cpt-codes-99490-99491-99487-99489-g0506-a-guide-to-chronic-care-management-ccm-codes-in-2022\/"},{"key":"bibr8-08971900231196624","doi-asserted-by":"publisher","DOI":"10.1016\/j.sapharm.2017.10.011"},{"key":"bibr9-08971900231196624","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.117.004188"},{"key":"bibr10-08971900231196624","doi-asserted-by":"publisher","DOI":"10.1002\/jac5.1435"},{"key":"bibr11-08971900231196624","doi-asserted-by":"publisher","DOI":"10.2146\/ajhp170723"},{"key":"bibr12-08971900231196624","doi-asserted-by":"publisher","DOI":"10.1093\/ajhp\/zxaa300"},{"key":"bibr13-08971900231196624","doi-asserted-by":"publisher","DOI":"10.1177\/08971900221148042"},{"key":"bibr14-08971900231196624","doi-asserted-by":"publisher","DOI":"10.1016\/j.japh.2021.01.017"},{"key":"bibr15-08971900231196624","doi-asserted-by":"publisher","DOI":"10.2105\/ajph.89.9.1322"},{"key":"bibr16-08971900231196624","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2019.00064"},{"key":"bibr17-08971900231196624","doi-asserted-by":"publisher","DOI":"10.1177\/08971900211008622"},{"key":"bibr18-08971900231196624","doi-asserted-by":"publisher","DOI":"10.1016\/j.sapharm.2020.01.001"}],"container-title":["Journal of Pharmacy Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08971900231196624","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/08971900231196624","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08971900231196624","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:38:16Z","timestamp":1777509496000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/08971900231196624"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,18]]},"references-count":18,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2024,8]]}},"alternative-id":["10.1177\/08971900231196624"],"URL":"https:\/\/doi.org\/10.1177\/08971900231196624","relation":{},"ISSN":["0897-1900","1531-1937"],"issn-type":[{"value":"0897-1900","type":"print"},{"value":"1531-1937","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,18]]}}}