Study Shows Pharmacists' Involvement In Patient Care Leads To Clinical, Economic Improvements

Main Category: Pharmacy / Pharmacist
Also Included In: Public Health
Article Date: 28 Jan 2008 - 3:00 PDT

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A study published in the Journal of the American Pharmacists Association (JAPhA) presents the most recent results from The Asheville Project - a community-based, pharmacist-directed, medication therapy management (MTM) program provided for several employers in the Asheville, N.C. area. In this study, more than 600 individuals being treated for hypertension and dyslipidemia, and receiving education and long-term MTM services from a pharmacist, achieved significant clinical and economic improvements that were sustained for as long as six years.

"To date, The Asheville Project has demonstrated long-term effectiveness for four chronic conditions: diabetes, asthma, hypertension and dyslipidemia," said Barry A. Bunting, PharmD, former clinical manager of pharmacy services, Mission Hospitals, Asheville, N.C., and lead author on this study. "The results of each study - seen also in this recent data of patients with hypertension and dyslipidemia - show that medication utilization increased nearly threefold, yet total health care costs decreased, primarily as a result of fewer emergency room and hospital visits. Much of this improvement can be attributed to the increased role the pharmacist played in providing health education and medication management guidance to these patients."

Clinical and economic benefits resulting from hypertension and dyslipidemia risk reduction education and long-term MTM by pharmacists were demonstrated in 12 community and hospital pharmacy settings over a six-year period. Several clinical indicators of patient's cardiovascular health improved over the course of the study, including:

- Percentage of patients at blood pressure goal increased from 40.2% at the start of the study to 67.4% by the study's end.

- Mean low-density lipoprotein (LDL) cholesterol decreased from 127.2 mg/dL at the start of study to 108.3 mg/dL by the study's end.

- Cardiovascular event rates fell by almost one-half, from 77 per 1,000 person-years during the historical period to 38 per 1,000 person-years during the study period.

"A recent study from The Commonwealth Fund found that while the United States is the global leader in health care spending, it ranks last among industrialized countries in preventing deaths from treatable conditions," said William M. Ellis, RPh, MS, Executive Director and CEO, American Pharmacists Association (APhA) Foundation. "With the Asheville Project, we saw a community-based disease management program that provides cardiovascular risk reduction education and face-to-face counseling by specially trained community and hospital pharmacists that resulted in significant clinical and financial outcome improvements. This model should be considered for populations with other preventable medical conditions for whom self-care knowledge and appropriate medication use are important for improving outcomes."

A cost benefit advantage was also demonstrated in a population with generally good baseline cardiovascular status (n=620). Mean cost per cardiovascular event in the study period was $9,931, compared with $14,343 during the historical period. Also during the study period, cardiovascular-related medical costs decreased by 46.5 percent, accounting for only 19 percent of total health care costs, down from 30.6 percent. This indicates that aggressively pursuing improvements in cardiovascular outcomes through pharmacist intervention in a broad population that includes at-risk patients, as well as patients who have yet to experience a cardiovascular event, can be cost effective.

Funding for independent data collection and analysis was provided by Novartis to the APhA Foundation.

About The Asheville Project

The Asheville Project began in 1996 as an effort by the City of Asheville, N.C., a self-insured employer, to provide education and personal oversight for employees with chronic health problems, such as diabetes, asthma, hypertension and high cholesterol. Through the Asheville Project, employees with these conditions were provided with intensive education through the Mission Hospitals Diabetes and Health Education Center. Patients were then teamed with community pharmacists who made sure they were using their medications correctly. Today, the Asheville Project has inspired a new health care model for individuals with chronic conditions.

About The APhA Foundation

The APhA Foundation is a not for profit 501(c)(3) organization headquartered in Washington, D.C., and is affiliated with the American Pharmacists Association (APhA), the oldest and largest national professional society of pharmacists in the United States. The APhA Foundation provides innovative programs and projects that contribute to new information and fresh ideas for pharmacists to use in retooling their practices to satisfy the contemporary health needs of their patients.

The APhA Foundation