Health & Medical Medications & Drugs

An Economic Analysis

An Economic Analysis
Study Objective: To determine if clinical pharmacists could affect economic resource use and humanistic outcomes in an ambulatory, high-risk population.
Design: Prospective, randomized, controlled study.
Setting: Nine Veterans Affairs medical centers.
Patients: Patients who were at high risk for medication-related problems.
Intervention: Patients were randomized to usual medical care with input from a clinical pharmacist (intervention group) or just usual medical care (control group).
Measurements and Main Results: Of 1054 patients enrolled, 523 were randomized to the intervention group and 531 to the control group. The number of clinic visits increased in the intervention group (p=0.003), but there was no difference in clinic costs. Mean increases in total health care costs were $1020 for the intervention group and $1313 for the control group (p=0.06).
Conclusion: Including the cost of pharmacist interventions, overall health care expenditures were similar for patients randomized to see a clinical pharmacist versus usual medical care.

A recent article documented the impact of a clinical pharmacist's participation on medical rounds in an intensive care unit at an academic medical center. The pharmacist's presence was associated with a 66% decrease in preventable adverse drug events. Another study documented reduced mortality and rate of heart failure when a clinical pharmacist was incorporated into the medical team.

Inappropriate use of drugs can have significant consequences. Over 16% of hospital admissions to an academic medical facility were related to drug-induced morbidity. Noncompliance with therapy was estimated to account for 5% of admissions. The cost of drug misuse by ambulatory patients alone was estimated at $76 billion (range $30-137 billion) in the United States.

Much of the pharmacy profession has adopted the concept of pharmaceutical care to improve the outcome of drug therapy. Pharmaceutical care is defined as "the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient's quality of life." Using this model, pharmacists in numerous settings have sought to reduce drug-related morbidity and mortality. Studies of pharmaceutical care, however, have been based on only one study site, did not have a control group, or did not randomize patient assignment. Another common problem with previous research is that interventions were not focused necessarily on patients who most likely would benefit from clinical pharmacy services. This study, which sought to overcome these limitations, is referred to as the IMPROVE study (Impact of Managed Pharmaceutical Care on Resource Utilization and Outcomes in Veterans Affairs Medical Centers). Its purpose was to determine if clinical pharmacists could affect economic resource use and humanistic outcomes in a population of veterans identified to be at high risk to experience a medication-related problem.



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