HMO pharmacists help manage high-risk patients
Drug counseling reduces costs
A two-year study of pharmacist-to-patient consultations confirms the hypothesis of Kaiser Permanente’s California Division in Pasadena that counseling and education from pharmacists reduces urgent care and inpatient costs for high-risk patients.
During the course of the study, patients who received pharmacist counseling reduced their probability of going to the hospital by 6% and showed a decrease in their urgent care use, with a corresponding decrease in total health care costs of between 3% and 14%, says Matthew Nye, PharmD, staff assistant to the director of pharmacy for Kaiser Permanente’s California Division.
Kaiser randomized 6,000 members who volunteered for the pharmacy study, says Jeff McCombs, PhD, an associate professor in the Department of Pharmaceutical Economics and Policy at the University of Southern California (USC) School of Pharmacy in Los Angeles. The 6,000 members were randomly assigned to specific pharmacies at the beginning of the study.
Pharmacies were instructed to follow one of the following three models:
• Control pharmacies provided drug education or counseling to patients only by patient request or when the pharmacist deemed that consultation was required.
• The second group of pharmacies followed new state of California guidelines, which require pharmacist-to-patient counseling for all new or changed prescriptions. Counseling must include directions for use, precautions and warnings, and proper storage instructions.
• The third group followed a special Kaiser model requiring pharmacist-to-patient counseling for any patient taking five or more chronic medications and for all new prescriptions for high risk medications, such as drugs with a narrow therapeutic index and those with a high propensity to cause drug reactions.
PharmD is conduit of information’
"These consultations for high-risk patients in the Kaiser model went far beyond the basic state requirements," says Nye. He explains that pharmacist-to-patient consultations in the Kaiser model included the following issues, as necessary:
• comprehensive education about the patient’s drug therapy, including the consequences of noncompliance;
• over-the-counter drugs to avoid while on the prescription;
• lab tests needed while on the medication;
• referrals to preventive medicine classes or classes designed for patients with specific chronic illnesses.
"The pharmacist acted as a conduit of information about Kaiser’s disease management and health education programs," Nye says. "In a health maintenance organization as large as Kaiser, there are many resources that patients can take advantage of, but they are often unaware of what is available to them."
The pharmacist also consulted with the patient’s primary care physician if two medi-cations were prescribed for the same indica- tion or other questions about therapy arose, he says.
"The idea of the Kaiser model was to do more for fewer patients by focusing resources on high-risk patients," McCombs adds.
Researchers at USC collected data at baseline, 12 months, and 24 months through surveys mailed to patients’ homes and from Kaiser claims data, McCombs says. Information collected included the following:
• patient satisfaction with pharmacy services;
• patient function and quality of life data;
• patient use of urgent care services;
• patient use of acute care services;
• patient use of office visits.
In general, patients in both the state model pharmacies and Kaiser model pharmacies reported being more satisfied with their pharmacy services even if they had to wait for pharmacist-to-patient consultations.
"At the end, we concluded that pharmacist-to-patient consultations are effective at stopping the train wrecks from happening," McCombs says. "Even though office visits actually went up, perhaps due to awareness of drug side effects, for every prescription filled using the Kaiser model there was some savings in total costs for high-risk patients."
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