Drug Topics -- Article dated 3/6/2000
All of the data gathered in this project was gathered and aggregated using the health outcomes management products.
TROUBLESHOOTERS
Iowa demonstration project finds pharmacists solving many drug therapy problems
By: Carol Ukens
In an Iowa demonstration project designed to determine the impact of pharmaceutical care, community pharmacists were found to have resolved drug therapy problems in 14% of their patient encounters.
A total of 1,171 patients received pharmaceutical care services in the Iowa study. During the two-year project, 9,517 patient care encounters were tallied, resulting in the resolution of 1,451, or 14% of drug therapy problems. Wellmark Blue Cross and Blue Shield of Iowa, the Iowa Pharmacy Association, and the Outcomes Pharmaceutical Health Care network of pharmacies were partners in the project. Patients with asthma, hypertension, diabetes, or ischemic heart disease were identified and enrolled by pharmacists to participate in the project. Patients received health-care services based on their overall health, not just the disease state for which they were enrolled.
?This study points to the fact that drug therapy problems are very prevalent,? said Cheryl Clarke, R.Ph., senior v.p., clinical and quality assurance services, Iowa Pharmacy Association. ?It also shows that pharmacists play an important role in identifying and resolving those drug therapy problems,? she said.
The most common medication trouble spots the pharmacists were able to clear up were inappropriate adherence to therapy, adverse drug reactions, and missing medication therapy. The majority of the problems were fixed through pharmacist intervention with the patient. More than 60% of the problems were at the low end of the severity scale, Clarke said. She said it has been postulated that the enrolled patients were those who could physically get to the pharmacy, which may have eliminated people with more sever conditions and more severe drug problems.
A total of 34 pharmacies actually enrolled patients, and 29 of them were reimbursed for their cognitive services. Reimbursement was calculated on a resource-based relative-value scale (RBRVS), which is the yardstick used to pay physicians. The pharmacists were paid a minimum of $14 for quarterly monitoring of patient visits. Higher reimbursements were earned if drug therapy problems were spotted and resolved. Quarterly payments ranged from $14 to $105 per patient, jdepending on the complexity of the patient?s medical needs, the number of medications used, and the number of drug therapy problems uncovered and resolved by the pharmacist, Clarke said.
When Wellmark analyzed the claim data, total medical expenditures for the pilot group were $1.86 million, compared with $2.53 million for a control group matched by age, gender, and disease state. Administrative costs for the pilot intervention group were $300,000, of which payments to pharmacists accounted for $122,605. The unadjusted cost per patient in the intervention group was $232 lower than that for the control group.
An analysis was then done to account for the higher disease severity among the control group. After that adjustment, the two groups were very similar in terms of cost: $3,762 versus $3,705.
On another pilot project front, Iowa pharmacy leaders had hoped the state would move forward this spring to get a Health Care Financing Administration state plan amendment for a pilot to test Medicaid reimbursements to pharmacists. State budgetary limitations have temporarily sidetracked that project, but Clark said leaders are now looking at revising the April 1 start date to a July 1 implementation. |
