Outcomes-based Pharmacist Reimbursement: Reimbursing Pharmacists for Cognitive Services (Part 1 of a 2-part series)

Farris, Karen B.; Kumbera, Patty; Halterman, Tom; Fang, Gang

doi:10.18553/jmcp.2002.8.5.383

Cited by 36 publications

(31 citation statements)

References 17 publications

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“…28 Although findings of some studies call into question the relationship between improved medication adherence and clinical outcomes or health care costs, 26,29 other studies have found a beneficial effect of adherence on clinical outcomes. 20,30 Recognizing drug interactions and adverse drug reactions are part of the expertise of a clinical pharmacist and may have contributed to minimizing ER visits in the intervention group as evidenced in other settings. [20][21][22]25 For example, the comparison group in the present study included a woman older than 80 years of age who was prescribed a low-dose tertiary Untreated indication: Recommendation to start a medication for a medical condition that is currently untreated but considered a standard of care…”

Section: A Prospective Trial Of a Clinical Pharmacy Intervention In Amentioning

confidence: 99%

“…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.…”

mentioning

confidence: 99%

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

Altavela¹,

Jones²,

Ritter³

2008

JMCP

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BACKGROUND: There is evidence that pharmacist interventions improve clinical outcomes. The few studies that address economic outcomes (a) often report estimated instead of actual medical costs, (b) report only medication costs, or (c) have been conducted in settings that are not typical of community-based primary care.OBJECTIVES: To (a) determine whether a clinical pharmacist's recommendations to physicians regarding optimizing medication therapy are related to medical costs in capitated patients in an internal medicine practice, and (b) compare what primary care physicians (PCPs) in a comparison group actually did proactively to optimize medication therapy versus what a clinical pharmacist would have recommended to them.METHODS: This was a prospective, controlled study comparing 2 internal medicine practices. Study enrollment was performed using a screening process carried out every 1-2 weeks on a rolling basis for 1 year from July 2001 through June 2002. Eligibility criteria for prospective enrollment were (a) 1 or more risk factors: at least 1 chronic disease or an event (e.g., emergency room visit, adverse drug reaction, medication nonadherence) or aged 50 years or older, (b) a scheduled visit to see a PCP within 2 weeks from the screening date or a diagnosis of diabetes without a PCP visit during the first 6 months of the study, (c) need for optimization of medication therapy as determined by a clinical pharmacist on the screening date, and (d) 12 months of continuous insurance eligibility before enrollment in the study. For inclusion in the final study analyses, patients were also required to have continuous insurance eligibility through 12 months from study enrollment. One clinical pharmacist made recommendations to optimize medication therapy in the intervention group. For the comparison group, the same pharmacist proposed recommendations that remained concealed from the physicians. The primary outcome measure was per patient per year (PPPY) medical cost, based on plan liability (gross allow able costs minus patient costs), excluding prescription drug cost. Additional outcome measures included numbers of outpatient visits, hospital admissions, emergency room (ER) visits per 1,000 patients, and hospital days; and percent of recommendations that were accepted by the PCPs. Changes in outcome measures from the pre-intervention to postintervention period were compared across study groups in a difference-indifference analysis, using the Student's t-test for normally distributed data and the Mann-Whitney U-test (nonparametric) for skewed data.RESULTS: There were 127 and 216 adult patients in the intervention and comparison groups, respectively. The primary outcome, change in mean PPPY medical (excluding pharmacy) cost, did not differ significantly between the groups (P = 0.711). The between-group difference in the change in ER visits per 1,000 patients approached statistical significance (P = 0.054). Intervention group patients were more likely than comparison group patients to have the following issues...

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Section: A Prospective Trial Of a Clinical Pharmacy Intervention In Amentioning

confidence: 99%

mentioning

confidence: 99%

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

Altavela¹,

Jones²,

Ritter³

2008

JMCP

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“…Some limited examples of compensation systems exist in the private and public sector. 43,44 ss Meeting the Challenge There are several challenges in implementing the above recommendations for making pDUR systems more useful. These can be grouped into those involving (a) the technical aspects of these systems and (b) how health care providers, particularly pharmacists, interpret and respond to potential drug therapy problem alerts generated by the systems.…”

Section: Ss Next Steps For Quality Improvement In Prospective Durmentioning

confidence: 99%

“…We believe that such a compensation policy is both feasible and practical. 43,44 ss Summary and Conclusion Despite its noble purpose, a growing body of literature documents numerous problems and concerns with respect to the quality of DUR criteria, DUR alerts, and the response of health care professionals to these alerts. Problems with the current pDUR "system" can be grouped into those involving technical aspects (e.g., duplicate messaging from in-store and online systems, or message text limitations) and those involving human aspects, specifically how pharmacists and other health care providers interpret and respond to potential drug therapy problem alerts generated by the electronic systems.…”

Section: Health Providers' Response To Prospective Dur System Alertsmentioning

confidence: 99%

Current Status of Prospective Drug Utilization Review

Fulda¹,

Lyles²,

Pugh³

et al. 2004

JMCP

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“…[9][10][11] In addition, mechanisms by which community pharmacists can document outcomes and obtain reimbursement for such cognitive services-outcomes-based pharmacist reimbursement (OBPR)-have been developed and evaluated. 12 Community pharmacists have been identified as potentially playing a key role in improving the education of women regarding the management of menopause. 13 By providing menopausal education in this setting, pharmacists can increase women' s knowledge and understanding of this topic to help open the lines of communication with their health care providers.…”

Section: Introductionmentioning

confidence: 99%

Assessment of the Effects of a Community Pharmacy Women's Health Education Program on Management of Menopause Survey Scores

Zeolla

Cerulli²

2004

JMCP

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Outcomes-based Pharmacist Reimbursement: Reimbursing Pharmacists for Cognitive Services (Part 1 of a 2-part series)

Cited by 36 publications

References 17 publications

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

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

Current Status of Prospective Drug Utilization Review

Assessment of the Effects of a Community Pharmacy Women's Health Education Program on Management of Menopause Survey Scores

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