Company Brochure on Pharmaceutical Care
Health Outcomes Management, Inc.
2331 University Avenue SE
Minneapolis, MN 55414
612-378-3053 www.homi.com
There is no automatic feedback loop in medicine today. If the patient does not continue to voice a concern about their condition, it is considered resolved by their physician. It has been estimated that for every dollar spent on drugs, another dollar is spent addressing problems caused by them.1 In the US, this amounts to approximately $88 billion annually.
Pharmaceutical industry studies have indicated that in the US, 1.3 million hospitalizations and 63,000 deaths are caused by the use of prescription drugs each year.2 This would suggest that you are ten times more likely to get injured by a prescription drug than by an auto accident in any given year. It also indicates that the number of people who commit suicide, are murdered, or die in auto accidents combined is roughly equal to the number of people who die as a result of what comes out of a prescription bottle in any given year.
These sobering figures indicate that we not only have a problem but that we have a major public health issue that merits substantial national attention.
Pharmaceutical Care
The term ?pharmaceutical care? has begun to get lot of notice lately. It is intended to describe a service distinctly different from traditional pharmacy dispensing activities. Due to a lack of a universally excepted practice definition, the term has come to mean different things to different people.
We define ?pharmaceutical care? first and foremost as a patient care practice. Its focus is on the patient and their medications, but is not dependent on a product being dispensed. It is a process, rather than an event. It is one in which the pharmacist takes responsibility for meeting the patient?s drug-related needs and is held accountable for this commitment.3 It is a relationship that is maintained over time.
In a way, a pharmacist practicing pharmaceutical care is like a personal health trainer. They gather some demographic information on the patient, determine what the patient and the doctor?s therapeutic goals are, design a plan to reach those goals, and follow-up with the patient the make sure the goals were met.
To take responsibility means the pharmacist identifies, and resolves, drug therapy problems. A drug therapy problem is a situation that, if left unresolved, prevents a patient from realizing the full benefits of their drug therapy. To be recognized as a drug therapy problem, the patient, the physician, and the pharmacist must all agree there is a problem and therapy is changed as a result. We further make the distinction between ?pharmaceutical care? and ?disease state management.? In our view, emphasizing a disease over the patient?s total therapy is inconsistent with pharmaceutical care. We need to manage patients, not diseases.
Rational Assessment Model
One of the main things we train pharmacists to do in their practice of pharmaceutical care is to use a rational and consistent assessment process for each patient. The assessment model that we teach requires the pharmacists to address each of the following issues in this order:
- Is the medication properly indicated?
- Is the medication as effective as possible given the patients circumstances?
- Is the medication safe for the patient to take?
- Given that the above concerns have been addressed, have I removed as many barriers to compliance as possible?
Impact of Pharmaceutical Care
To address this enormous problem, a large-scale study examined the pharmacist?s impact on improving therapy outcomes. The study was conducted between June of 1992 and November of 1995. Principle investigators were from the University of Minnesota?s Peters Institute of Pharmaceutical Care, with collaboration from the Minnesota Pharmacists Association, the Minnesota State Board of Pharmacy, local managed care organizations, the pharmaceutical industry, and Health Outcomes Management, Inc.
Participating were 54 pharmacists from twenty community pharmacies throughout Minnesota. Together they provided pharmaceutical care to over 9,000 patients through some 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 pharmacist by working with the patient and their physician.
The nature of the drug therapy problems discovered fall into the following categories:
Indication
Needs additional therapy 23%
Unnecessary drug therapy 7%
Effectiveness
More effective drug available 16%
Dosage too low to be effective 15%
Safety
Adverse drug reaction 21%
Dosage too high to be safe 6%
Compliance
Inappropriate compliance 12%
100%
Source: Cipolle, et al Pharmaceutical Care Practice 1998
Pharmaceutical care increased the number of patients meeting therapeutic goals by 15% within the first year. Economic data generated by the study revealed an extremely high potential for a positive return on investment. In fact, Steve Schondelmeyer of the University of Minnesota PRIME Institute analyzed the results and reports a potential benefit in excess of $10 for every $1 invested in providing pharmaceutical care for patients over 65 years of age.4 We expect the general population to receive a $3 to $10 return for every $1 spent. |
