Patient-focused Care
The Opportunity
The Pharmacist
Can Optimize
Drug Therapy
The Pharmacist
is Uniquely
Qualified
Pharmaceutical Care
Pharmaceutical Care has
taken on a new meaning:
Patient-focused care.
Recently, West Virginia University has been part of the national leadership on Pharmaceutical Care by offering the Doctor of Pharmacy (Pharm.D.) degree. This degree shifts traditional pharmacy education from a product-based emphasis to one that is patient-focused. Patient-focused education enables the primary care pharmacist to assess and monitor the patient's response to their medication therapy and determine necessary modifications to that therapy. The result is an optimization of the pharmaceutical care delivery system and the consequent improvement in the quality of life for patients receiving medication therapy.
The Opportunity is Great
76 billion dollars saved in health care expenditures and 120,000 deaths per year prevented nationally if pharmacists were more fully utilized in community health care, so concludes an investigative study published in the Archives of Internal Medicine1. This means that for every health care dollar spent on purchasing medications, an additional dollar is being spent to deal with misuse of medications. The poor and the elderly are the most likely to suffer from prescription drug misuse. Pharmacists are the most accessible health care professional and they are being greatly underutilized. The potential for improvement in quality of life and in cost reductions is great.
A total of 23.5 percent of people aged 65 years or older living in the community received at least one of 20 drugs which should never be used in the elderly according to a 1994 study published in the Journal of the American Medical Association2. This is consistent with the finding published by the General Accounting Office that about 17.5 percent of the 30 million Medicare recipients treated in non-institutional settings are being prescribed drugs which are unsafe for their age group or are duplicates of other medications.
Estimates of all hospital admissions due to poor compliance of medication therapy is a whopping 5.3 percent3. However, when the incidence of hospital admission is estimated by considering any drug-related problem the hospitalization rate is a staggering 11.3 to 28.2 percent!1
West Virginians deserve the right to obtain the most cost-effective pharmacist care, not just to reduce expenditures, but to enhance their quality of life. The value of actions taken by pharmacists to optimize medication therapy have long been documented. In a recent study published in the Annals of Pharmacotherapy, these interventions resulted in a savings of $122.98 saved for each problem prescription. Two percent of all prescriptions had the potential for serious adverse health outcomes.4 In another study, a pharmacist's therapy recommendations decreased the number of medications that each patient was on and saved $586 per year.5 In a California managed care study, a savings of $664 per patient per year was realized by a pharmacist-managed medication review clinic.6 Pharmacists have been preventing errors and resolving problem prescriptions for decades with little public recognition of their role.
The Pharmacist is Uniquely Qualified to Provide Patient-Focused Pharmaceutical Care
No other health care professional possess the foundation of knowledge that pharmacists have about medications. This has not gone unnoticed, the nation's largest health maintenance organization (HMO) utilizes a group of pharmacists on a full time basis to present objective information to their physicians. This is one of the many pharmacist-oriented educational programs which are utilized to ensure that patients receive the optimal medication therapy to treat their illnesses and enhance their quality of life. Further evidence of pharmacist-led care to improve patient outcomes include:
Asthma patients who were high users of hospital Emergency Room for acute attacks demonstrated an 80 percent decline in the frequency of Emergency Room visits as a result of ongoing pharmacist efforts.7
Geriatric consumers were able to reduce the number of prescriptions and increase compliance with their medication regimen after counseling by pharmacists.8
Community Pharmacists resolve problematic prescription drug therapy in about 2 percent of all new prescriptions, with about 28 percent of these judged capable of causing "patient harm" if the Pharmacist had not intervened.9
Physicians accepted about 83 percent of pharmacists' recommendation to alter medication therapy in an ambulatory clinic. Eighty percent of these recommendations resulted in, "improvement or resolution of patient's disease state", as well as cost reductions.10
Hypertensive patients who received pharmacist interventions were more compliant with their treatment and obtained better blood pressure control than with traditional measures.11
Expanded Pharmacist Role in Improving the Quality of Life for Patients
Nationwide, more than half the states have already established guidelines for pharmacists to have limited prescribing ability in a collaborative partnership with primary care physicians. Nationally, the Veterans Administration allows limited prescriptive authority for pharmacists. The potential is greatest for rural West Virginia where such services can expand the practice of rural primary care physicians.
R E F E R E N C E S
1. Johnson J A, and Bootman J L. Drug-related Morbidity and Mortality: A Cost-of-Illness Model. Archives of Internal Medicine. October 1995;155:1949-1956.
2. Wilcox S M., Himmelstein D U, and Woolhandler S. Inappropriate Drug Prescribing for the Community-Dwelling Elderly. JAMA. July 1994; 272: 292-296.
3. Sullivan SD, Kreling DH, and Hazlet TK. Noncompliance with Medication Regimens and Subsequent Hospitalization: a literature analysis and cost of hospitalization estimate. J Res Pharm Econ. 1990;2: 19-33.
4. Rupp MT. Value of Community Pharmacists' Interventions to Correct Prescribing Errors. Annals of Pharmacotherapy. 1992;26: 1580-1584.
5. Jameson J, VanNoord G, and Vanderwoud K. The Impact of a Pharmacotherapy Consultation on the Cost and Outcome of Medical Therapy. The Journal of Family Practice. Nov 1995; 41: 469-472.
6. Borgsdorf LR, Miano JS, and Knapp KK. Pharmacist-managed Medication Review in a Managed Care System. American Journal of Hospital Pharmacy. March 1994; 51: 772-777.
7. Pauley TR, Magee MJ, and Curry, JD. Pharmacist-managed, Physician-directed Asthma Management Program reduces Emergency Department Visits. Annals of Pharmacotherapy. Jan 1995; 29(1): 5-90.
8. Lipton HL, and Bird JA. The Impact of Clinical Pharmacists' Consultation on Geriatric patients' Compliance and Medical Care Use: A Randomized Controlled Trial. Gerontologist. June 1994; 34(3): 307-315.
9. Rupp MT, De Young M, and Schondelmeyer SW. Prescribing Problems and Pharmacist Interventions in Community Practice. Medical Care. Oct. 1992; 30(10): 926-940.
10. Lobas NH, Lepinski PW, and Abramowitz PW. Effects of Pharmaceutical Care on Medication Costs and Quality of Patient Care in an Ambulatory-care Clinic. American Journal of Hospital Pharmacy, July 1992; 49(7): 1681-1688.
11. McKenney JM, Slining JM, Henderson HR, Devins D, and Barr M. The Effect of Clinical Pharmacy Services on Patients with Essential Hypertension. Circulation. Nov. 1973; 48(5): 1104-
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