Should interventions play a role in reporting?
The answer depends on whom you ask
How pharmacist interventions are defined plays a major role within outcomes reporting. And like much of the theory of outcomes, each pharmacy director and health system administrator must decide what, if any, types of interventions or models are appropriate.
While emphasizing that interventions are "absolutely" a factor in outcomes reporting, Burt Finkelstein, PharmD, director of pharmacy and management services at Johns Hopkins Bayview Medical Center in Baltimore, stresses there are inherent pitfalls in this approach. "Interventions are simply hard to document, and it’s something that has driven me crazy," he admits. "We have looked at pharmacy clinical interventions in the ICU in terms of cost based on the pharmacist and nursing roles, and we have saved money in the analysis. But, we’re never sure that what the pharmacist recommended is going to save money throughout length of stay or whether a doctor will come up with the same conclusion a day later. We’ve looked at 24-hour and total cost avoidance, but it’s like a balloon, you push it in one place and it pops out in another."
Gordon Vanscoy, PharmD, MBA, vice chairman of the department of pharmacy and therapeutics at the University of Pittsburgh School of Pharmacy, also backs pharmacist interventions as a legitimate factor in outcomes reporting, provided they are clearly defined. "Pharmacist interventions can play a large role in areas like therapeutic substitution, which is in a patient’s best interest," he says. For example, one health system’s pharmacists identified doctors who were prescribing "suboptimal" doses of the protease inhibitor Crixivan to AIDS patients, he says. Wishing to prevent possible development of drug resistance, a pharmacy-led educational campaign turned into an 89% change in prescribing habits.
"Some people would say an intervention is a process. Now is that an end result of health care? Not really, but it is related. An intervention could help indicate an outcome, but an intervention is not an end result," says David Holdford, PhD, assistant professor of pharmacy administration at Virginia Commonwealth University’s Medical College of Virginia in Richmond.
Kathy Bungay, PharmD, senior project director for the Health Center at the New England Medical Center Hospital in Boston, is even more skeptical of whether interventions have a place in outcomes modeling. "Pharmacist interventions are actually going to have more impact on the process than the outcome," she says.
"For example," she continues, "having patients take their medicine will better their outcome, and we will have helped improve compliance as part of the process of taking medication. That’s an impact on a process but a smaller impact on the medication itself since you can’t disassociate the intervention from the particular drug in that case. The drug will have an effect since the patient is taking it, but the way the pharmacist is having an effect is through the process."
But like Finkelstein, Robert Spires, director of pharmacy at Lexington Medical Center in West Columbia, SC, is striving to make pharmacist interventions a part of outcomes reporting, initially through an analysis of how much time pharmacists are spending on interventions. "We try to show how the pharmacy is impacting patient care and the interventions we do are a part of outcomes. I think it’s the way to go."
[For more details, contact: Gordon Vanscoy, PharmD, MBA, Vice Chairman, Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, 1104 Salk Hall, Pittsburgh, PA 15261. Telephone: (412) 825-8331 Colleen O’Malley, MS, Director, ASHP Center on Managed Care Pharmacy, 7272 Wisconsin Ave., Bethesda, MD 20814. Telephone: (301) 657-3000. David Holdford, PhD, Assistant Professor of Pharmacy Administration, sVirginia Commonwealth University, Medical College of Virginia, 410 North 12th St., Richmond, VA 23298. Telephone: (804) 828-6103. Burt Finkelstein, PharmD, Director of Pharmacy and Management Services, Johns Hopkins Bayview Medical Center, 4940 Eastern Ave., Baltimore, MD 21224. Telephone: (410) 550-0100. Kathy Bungay, PharmD, Senior Project Director, New England Medical Center Hospital, P.O. Box 294, Boston, MA 02111. Telephone: (617) 636-3292. Robert Spires, RPh, Director of Pharmacy, Lexington Medical Center, 2720 Sunset Blvd., West Columbia, SC 29169. Telephone: (803) 791-2000.]
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