Effectiveness of an Ambulatory Care Clinical Pharmacist: A Controlled Trial

Abstract

An ambulatory care pharmacist is effective in identifying drug therapy problems, resulting in significant cost savings to the institution.

A Prospective Trial of a Clinical Pharmacy Intervention in a Primary Care Practice in a Capitated Payment System

“…For example, asthma and cardiovascular conditions are measured both for quality, such as appropriate medication use and medication adherence, and for the cost of care. 6,7 Some studies of clinical pharmacist activities have concentrated on lowering medication costs, 8,9 but few have attempted to look at the impact on medical health care costs and utilization. Lowering medication costs has been accomplished by simplifying medication regimens, recommending less expensive alternatives, and providing pharmacotherapy consultation directly to patients.…”

“…Lowering medication costs has been accomplished by simplifying medication regimens, recommending less expensive alternatives, and providing pharmacotherapy consultation directly to patients. [8][9][10] In an effort to decrease medical health care costs and utilization, some studies have demonstrated that pharmacists effectively identify potential and actual drug-related problems, potentially resulting in cost avoidance. 8,10 Previous studies that assessed clinical or medical cost outcomes were either conducted in U.S. Department of Veterans Affairs (VA) systems, in a setting where the patient was seen at a separate pharmacist visit, in a pharmacist-run clinic, or in populations that were dissimilar to general primary care internal medicine practices.…”

“…[8][9][10] In an effort to decrease medical health care costs and utilization, some studies have demonstrated that pharmacists effectively identify potential and actual drug-related problems, potentially resulting in cost avoidance. 8,10 Previous studies that assessed clinical or medical cost outcomes were either conducted in U.S. Department of Veterans Affairs (VA) systems, in a setting where the patient was seen at a separate pharmacist visit, in a pharmacist-run clinic, or in populations that were dissimilar to general primary care internal medicine practices. [10][11][12][13][14] Although these studies describe effective models, they do not extrapolate well to the typical primary care, internal medicine practice where medical patients are most often seen by physicians and in which pharmacists typically have no access to pertinent medical information (e.g., medical history, progress notes, laboratory and other test results, and consult notes) necessary to make clinical recommendations to prescribers.…”

“…Many other studies presenting medical health care cost outcomes have also been based on estimated costs, 8,12,14,[20][21][22] whereas fewer studies used actual costs. We were unable to assess differences in drug cost between the intervention group and comparison group in the present study because study enrollment criteria did not require that patients had prescription drug coverage during any part of the study.…”

Resident Physicians’ Acceptance of Pharmacy Students’ Pharmacotherapy Recommendations During an Ambulatory Care Advanced Pharmacy Practice Experience

“…[2][3][4][5][6][7] Interventions in an outpatient ambulatory care clinic made by a clinical pharmacist not only improved patient care, but also yielded a cost savings 4 times the pharmacist salary when compared to a similar clinic without a pharmacist. 8,9 To date, there have been no studies that compared pharmacy students' written versus verbal recommendations in an ambulatory clinic setting. The purpose of this study was to compare the acceptance rates of written versus verbal pharmacotherapy recommendations made by pharmacy students completing an ambulatory care APPE in an outpatient internal medicine clinic.…”