Clinical and economic outcomes of pharmacist recommendations in a Veterans Affairs medical center

Lee, Audrey J; Boro, Maureen S.; Knapp, Katherine K.; Meier, Joy; Korman, Nancy

doi:10.1093/ajhp/59.21.2070

Cited by 124 publications

(127 citation statements)

References 25 publications

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“…Each drug therapy problem was also assigned a category based on the pharmacists' recommendations. 31 Examples included identifying drug interactions, preventing or managing drug allergies, adjusting doses or frequencies, treatment of identified conditions, preventing or managing adverse drug events, preventing unnecessary drug therapy, and reducing duplication of therapy. Prescriber acceptance of pharmacist recommendations to resolve drug therapy problems was coded as accepted or not.…”

Section: Discussionmentioning

confidence: 99%

Improving Population Management through Pharmacist-Primary Care Integration: A Pilot Study

Kennedy

Chen

Corriveau

et al. 2015

Population Health Management

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Pharmacists have unique skills that may benefit primary care practices. The objective of this demonstration project was to determine the impact of integrating pharmacists into patient-centered medical homes, with a focus on population management. Pharmacists were partnered into 5 primary care practices in Vermont 1 day per week to provide direct patient care, population-based medication management, and prescriber education. The main measures included a description of drug therapy problems identified and cost avoidance models. The pharmacists identified 708 drug therapy problems through direct patient care (336/708; 47.5%), population-based strategies (276/708; 38.9%), and education (96/708; 13.6%). Common population-based strategies included adjusting doses and discontinuing unnecessary medications. Pharmacists' recommendations to correct drug therapy problems were accepted by prescribers 86% of the time, when data about acceptance were known. Of the 49 recommendations not accepted, 47/49 (96%) were population-based and 2/49 (4%) were related to direct patient care. The cost avoidance model suggests $2.11 in cost was avoided for every $1.00 spent on a pharmacist ($373,092/$176,690). There was clear value in integrating pharmacists into primary care teams. Their inclusion prevented adverse drug events, avoided costs, and improved patient outcomes. Primary care providers should consider pharmacists well suited to offer direct patient care, population-based management, and prescriber education to their practices. To be successful, pharmacists must have full permission to document findings in the primary care practices' electronic health records. Given that many pharmacist services do not involve billable activities, sustainability requires identifying alternative funding mechanisms that do not rely on a traditional fee-for-service approach.

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Section: Discussionmentioning

confidence: 99%

Improving Population Management through Pharmacist-Primary Care Integration: A Pilot Study

Kennedy

Chen

Corriveau

et al. 2015

Population Health Management

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“…In 1994, management of medication conducted by deploying clinical pharmacists was reimbursed by Japan's payment system. These reimbursements were justified by several international studies demonstrating the efficacy of pharmacy services in enhancing patient safety [30][31][32][33]. Of the seven participant hospitals, though one hospital (Hospital F) had sufficiently delivered clinical pharmacy services before 1999, several of them started to deploy clinical pharmacists after 1999, which resulted in increased incremental costs.…”

Section: Discussionmentioning

confidence: 99%

Cost of hospital-wide activities to improve patient safety and infection control: A multi-centre study in Japan

Fukuda¹,

Imanaka²,

Hayashida³

2008

Health Policy

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“…Despite the inability to accurately measure the extent to which these activities occur, the literature is replete with examples demonstrating how the clinical role of the pharmacist results in dramatic improvements in patient safety and decreased total costs of care. [26][27][28] Today's commercially available benchmarking systems do not effectively capture clinical activity or the extent of clinical activity. In addition, there is a great deal of variability in how people report clinical services, and this needs to be standardized in the future.…”

Section: External Benchmarking Systems and Their Limitationsmentioning

confidence: 99%

“…[26][27][28] In hospital pharmacy departments, drug costs often comprise 80-90% of total expenses while personnel represent as low as 10-20% of total departmental expenses. Therefore, labor efficiency metrics should never be reported in the absence of meaningful cost performance metrics, and pharmacy directors should insist on this if provided with only labor metrics from consultants or if asked to include a labor metric in the department's budgeting process.…”

Section: Examples Of Cost-based Productivity Ratiosmentioning

confidence: 99%

Effective use of workload and productivity monitoring tools in health-system pharmacy, part 1

Rough

McDaniel

Rinehart

2010

American Journal of Health-System Pharmacy

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Challenges with external operational benchmarking and internal productivity monitoring systems are numerous. These systems rarely measure the quality of pharmacy services provided and their effect on patient care outcomes and the total cost of care. Benchmarking vendors must modernize their software and develop internal checks to confirm data integrity in order to make their products more useful and reliable. In addition, data supporting the patient care role of the pharmacist should be integrated into all productivity monitoring systems and be used to demonstrate the positive impact of pharmacy services on the total cost and quality of patient care.

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Clinical and economic outcomes of pharmacist recommendations in a Veterans Affairs medical center

Cited by 124 publications

References 25 publications

Improving Population Management through Pharmacist-Primary Care Integration: A Pilot Study

Improving Population Management through Pharmacist-Primary Care Integration: A Pilot Study

Cost of hospital-wide activities to improve patient safety and infection control: A multi-centre study in Japan

Effective use of workload and productivity monitoring tools in health-system pharmacy, part 1

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