Pharmacist-Managed, Physician-Directed Asthma Management Program Reduces Emergency Department Visits

Pauley, Timothy; Magee, Michael; Cury, James

doi:10.1177/106002809502900101

Cited by 102 publications

(55 citation statements)

References 17 publications

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“…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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“…[19][20][21] Ultimately, 15 educational 22-36 and 9 system-level studies were included. [37][38][39][40][41][42][43][44][45] (Table 1) The education-based interventions primarily targeted patients while the system-level interventions targeted providers and/or health systems.…”

Section: Resultsmentioning

confidence: 99%

“…Nine system-level studies met criteria for this review. The setting was primarily outpatient; [40][41][42][43][44][45] three were inpatient-based. [37][38][39] Two utilized health disparities collaboratives to introduce quality improvement interventions.…”

Section: Intervention Sub-typesmentioning

confidence: 99%

“…42,44,45 These interventions were similar in that they were clinicbased and utilized experts, including pharmacists 44,45 and specialty-based clinics (e.g., allergists). 42,45 All three found a relative 42,45 or absolute 44 decrease between 63-87 %; the control group in one study actually had increased ED visits by 71 %. 42 These three studies, along with another clinicbased intervention that used multiple sessions and a hospital-based nurse-led intervention, both by Mayo, followed hospital admissions.…”

Section: Intervention Outcomesmentioning

confidence: 99%

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Interventions to Improve Outcomes for Minority Adults with Asthma: A Systematic Review

et al. 2012

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OBJECTIVES:To systematically review the literature to characterize interventions with potential to improve outcomes for minority patients with asthma. DATA SOURCES: Medline, PsycINFO, CINAHL, Cochrane Trial Databases, expert review, reference review, meeting abstracts. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTEVENTIONS: Medical Subject Heading (MeSH) terms related to asthma were combined with terms to identify intervention studies focused on minority populations. Inclusion criteria: adult population; intervention studies with majority of non-White participants. STUDY APPRAISAL AND SYNTHESIS OF METHODS:Study quality was assessed using Downs and Black (DB) checklists. We examined heterogeneity of studies through comparing study population, study design, intervention characteristics, and outcomes. RESULTS: Twenty-four articles met inclusion criteria. Mean quality score was 21.0. Study populations targeted primarily African American (n=14), followed by Latino/a (n=4), Asian Americans (n=1), or a combination of the above (n=5). The most commonly reported post-intervention outcome was use of health care resources, followed by symptom control and self-management skills. The most common intervention-type studied was patient education. Although less-than half were culturally tailored, language-appropriate education appeared particularly successful. Several system-level interventions focused on specialty clinics with promising findings, although health disparities collaboratives did not have similarly promising results. LIMITATIONS: Publication bias may limit our findings; we were unable to perform a meta-analysis limiting the review's quantitative evaluation. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS:Overall, education delivered by health care professionals appeared effective in improving outcomes for minority patients with asthma. Few were culturally tailored and one included a comparison group, limiting the conclusions that can be drawn from cultural tailoring. Systemredesign showed great promise, particularly the use of team-based specialty clinics and long-term follow-up after acute care visits. Future research should evaluate the role of tailoring educational strategies, focus on patient-centered education, and incorporate outpatient follow-up and/or a team-based approach.

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A Prospective, Randomized Trial to Assess the Cost Impact of Pharmacist-Initiated Interventions

McMullin¹,

Hennenfent²,

Ritchie³

et al. 1999

Arch Intern Med

152

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Pharmacist-Managed, Physician-Directed Asthma Management Program Reduces Emergency Department Visits

Abstract: The comprehensive asthma management program reduced the number of ED visits for acute exacerbations of asthma.

Cited by 102 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

Interventions to Improve Outcomes for Minority Adults with Asthma: A Systematic Review

A Prospective, Randomized Trial to Assess the Cost Impact of Pharmacist-Initiated Interventions

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