Drug Topics, an industry publication Article dated 7/5/99
This article was published in the July 5, 1999 issue of Drug Topics
Generalist pharmaceutical care: Is it a better model?
While much of the pharmacy universe advocates or pursues credentialing as a means to gain reimbursement, a Minneapolis company claims to have found a better way -- one it claims will benefit pharmacists, patients, and insurers alike. Health Outcomes Management Inc. employs what it calls a "generalist" model of pharmaceutical care, differentiating itself from the practice of disease management -- a term that v.p. Michael Frakes, Pharm.D., seems to find distasteful. "We're not treating diseases, we're treating patients," he explained.
The problem with the disease management model, added company president Peter Zugschwert, is that providers focus so intensely on one condition. "If the disease happens to be asthma, they're there to manage your asthma. That's what they get paid to do," he said. "From our perspective, it's wrong thinking."
Right thinking, according to the company, is helping to solve medication-related problems wherever they arise. Through the generalist model, the company maintains, pharmacy can have the most significant impact on patient health and the cost of health-care delivery and provide a service for which pharmacists can reasonably expect to be reimbursed.
An Overview of Patient-Centered Pharmaceutical Care, a paper prepared by Health Outcomes Management, cites Prescription for Disaster by Thomas Moore (Simon & Schuster, 1998) as the source for a startling statistic: 1.3 million hospitalizations and 63,000 deaths are caused by the use of prescription drugs every year.
What's the problem?
The nature of the drug therapy problems found in 43% of study patients breaks down as follows:
Effectiveness
Better drug available 16%
Dosage too low 15%
Indication
Needs additional therapy 23%
Unnecessary drug therapy 7%
Safety
Adverse drug reaction 21%
Dosage too high 6%
Compliance
Inappropriate compliance 12%
In an effort to prove that R.Ph.s can prevent potential medication problems from becoming reality, Health Outcomes Management worked with the University of Minnesota's Peters Institute of Pharmaceutical Care, the Minnesota Pharmacists Association, the Minnesota pharmacy board, and local managed care organizations on a study, conducted from June 1992 to November 1995, that included 54 R.Ph.s from 20 community pharmacies throughout Minnesota. Combined, they provided care to more than 9,000 patients in 25,000 patient encounters. The study found that 43% of the patients seen had at least one drug therapy problem identified and resolved by a study R.Ph. working with the patient and physician.
Issues concerning effectiveness of a drug surfaced in 31% of the patients who had such a problem, followed by indication problems (30%), safety concerns (27%), and compliance (12%). According to the company, generalist pharmaceutical care increased the number of patients meeting therapeutic goals by 15% in the first year. Health Outcomes Management predicted a return of $3 to $10 for every $1 invested in the general population. Frakes added that company data indicate compliance problems in the generalist model run around 10%, versus rates as high as 50% in other models.
In addition, R.Ph.s in the study were compensated when they solved a problem by working with the patient and physician. "In a way we're saying: You're not paying us to meet with people and assess people. You're sharing some of the savings with us that we find for you. If we prevent an emergency room visit, you're sharing some of that with us," Zugschwert said.
What the company offers pharmacists now is an education in "how to do all these things," according to Zugschwert. The program is open to chains and independents alike, though independents would be best served by banding together in a group. "You need to be able to commit to doing enough stores in a given metropolitan area that you can go out and contract either with a third-party payer or directly with a company that may be self-insured," he explained, adding that it takes 10-30 stores to have "a meaningful impact."
Eckerd has begun working on the generalist model and is training its first group of participating R.Ph.s. Now the company is in discussion with other chains in the United States and Europe. "We know this model works," said Frakes. "We just have to get enough people doing it in large enough scale that insurance companies can market it and get it paid for."
Harris Fleming Jr. |
