ALL /PHASE

ALL /PHASE

Introduction

The practice of pharmacy in the outpatient setting is at a critical juncture. While patient consultation in the ambulatory pharmacy setting has been mandated in several states for all patients' and by federal law for Medicaid patients, 2 regulatory mandates and legislation alone cannot sustain the long-term viability of pharmaceutical care in the outpatient setting. Cost-conscious health insurance plans, health maintenance organizations (HMOs), and government programs cannot justify devoting scarce resources to community based pharmaceutical care unless its cost effectiveness can be demonstrated. Without supportive research, the development, implementation, and refinement of new ambulatory care models by the pharmacy profession, insurance companies, HMOs, and boards of pharmacy will be significantly impaired. (Campbell 2011)

Theoretical Foundation

Rapid technological changes in medicine, including new drugs, have increased the complexity of outpatient drug regimens, especially those prescribed to control chronic health conditions. Health care cost-containment initiatives, such as the Medicare prospective payment system for hospitals, have increased the complexity of medical conditions treated on an outpatient basis. I1 The elderly use a disproportionate share of prescribed medications and hospital admissions, and the US population is aging. l2 The growth of managed care and the health care reform movement have increased pressure on providers to develop innovative approaches to health care delivery. As a result, the paradigm of “pharmaceutical care” has emerged as a potential tool to improve patient outcomes while reducing health care costs. The results of this patient consultation study could have a significant effect on both (Edelman et. al.. 2010)

Question of Focus

The KP model of outpatient pharmacy practice was designed to use the same level of total organizational resources as the state model to facilitate the comparison of the relative effectiveness of the two models. The KP model was also compared with the control model. A third objective of this study was to investigate the relationship between patient-encounter characteristics and the resource cost of the encounter. These characteristics included patient age, sex, ethnicity, the type of medication dispensed, the number of concomitant medications, the type of medication problems discovered by the pharmacist, if any, and whether resolution of the problem required contact with the prescribing physician (Gunderson et. al.. 2011). The effects of the three alternative models of patient consultation were measured along two dimensions: (1) health care use and cost, and (2) patient health status and quality of life. The total cost of the health care was estimated by valuing the services consumed by study participants using standardized prices, such as the national Medicare Resource-Based Relative Value Scale (RBRVS) fee schedule for physician services and diagnosis-related group (DRG) payments for hospital admissions. Quality-of-life effects were measured using annual patient surveys. These data allow the investigation of the cost-utility effects of outpatient pharmaceutical services by comparing the impact of the intervention on a patient's well-being against the net cost of the intervention. Drug therapy outcomes also were investigated to determine if the process of drug therapy was affected by the altemative practice models. Drug therapy process measures included patient compliance and the ...