A randomized, controlled trial of a clinical pharmacist intervention to improve inappropriate prescribing in elderly outpatients with polypharmacy

Hanlon, Joseph T.; Weinberger, Morris; Samsa, Gregory P.; Schmader, Kenneth E.; Uttech, Kay M.; Lewis, Ingrid K.; Cowper, Patricia A.; Landsman, Pamela B.; Cohen, Harvey Jay; Feussner, John R.

doi:10.1016/s0002-9343(97)89519-8

Cited by 537 publications

(563 citation statements)

References 38 publications

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“…Hanlon et al also recorded concealed recommendations for a randomized control group and found that, similar to the present study's results, 55.1% of intervention group and 19.8% of control group physicians enacted the clinical pharmacist's recommended changes. 27 In the present study, between-group differences in the rates of optimized medication therapy may have contributed to the trend in lower hospital admissions and ER visits for patients provided with clinical pharmacist services. For example, medication nonadherence, leading to poor disease control, also can lead to increased hospitalizations and can be an important driver of overall medical costs.…”

Section: A Prospective Trial Of a Clinical Pharmacy Intervention In Amentioning

confidence: 66%

A Prospective Trial of a Clinical Pharmacy Intervention in a Primary Care Practice in a Capitated Payment System

Altavela¹,

Jones²,

Ritter³

2008

JMCP

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BACKGROUND: There is evidence that pharmacist interventions improve clinical outcomes. The few studies that address economic outcomes (a) often report estimated instead of actual medical costs, (b) report only medication costs, or (c) have been conducted in settings that are not typical of community-based primary care.OBJECTIVES: To (a) determine whether a clinical pharmacist's recommendations to physicians regarding optimizing medication therapy are related to medical costs in capitated patients in an internal medicine practice, and (b) compare what primary care physicians (PCPs) in a comparison group actually did proactively to optimize medication therapy versus what a clinical pharmacist would have recommended to them.METHODS: This was a prospective, controlled study comparing 2 internal medicine practices. Study enrollment was performed using a screening process carried out every 1-2 weeks on a rolling basis for 1 year from July 2001 through June 2002. Eligibility criteria for prospective enrollment were (a) 1 or more risk factors: at least 1 chronic disease or an event (e.g., emergency room visit, adverse drug reaction, medication nonadherence) or aged 50 years or older, (b) a scheduled visit to see a PCP within 2 weeks from the screening date or a diagnosis of diabetes without a PCP visit during the first 6 months of the study, (c) need for optimization of medication therapy as determined by a clinical pharmacist on the screening date, and (d) 12 months of continuous insurance eligibility before enrollment in the study. For inclusion in the final study analyses, patients were also required to have continuous insurance eligibility through 12 months from study enrollment. One clinical pharmacist made recommendations to optimize medication therapy in the intervention group. For the comparison group, the same pharmacist proposed recommendations that remained concealed from the physicians. The primary outcome measure was per patient per year (PPPY) medical cost, based on plan liability (gross allow able costs minus patient costs), excluding prescription drug cost. Additional outcome measures included numbers of outpatient visits, hospital admissions, emergency room (ER) visits per 1,000 patients, and hospital days; and percent of recommendations that were accepted by the PCPs. Changes in outcome measures from the pre-intervention to postintervention period were compared across study groups in a difference-indifference analysis, using the Student's t-test for normally distributed data and the Mann-Whitney U-test (nonparametric) for skewed data.RESULTS: There were 127 and 216 adult patients in the intervention and comparison groups, respectively. The primary outcome, change in mean PPPY medical (excluding pharmacy) cost, did not differ significantly between the groups (P = 0.711). The between-group difference in the change in ER visits per 1,000 patients approached statistical significance (P = 0.054). Intervention group patients were more likely than comparison group patients to have the following issues...

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Section: A Prospective Trial Of a Clinical Pharmacy Intervention In Amentioning

confidence: 66%

A Prospective Trial of a Clinical Pharmacy Intervention in a Primary Care Practice in a Capitated Payment System

Altavela¹,

Jones²,

Ritter³

2008

JMCP

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“…Pharmacists based on primary care practices currently assist with medication therapy management, polypharmacy and poor medication adherence [30][31][32][33]. Specifically, we assessed the utilization of pharmacist support and its impact on the use of PGx testing during and after the study.…”

mentioning

confidence: 99%

Primary Care Providers’ Use of Pharmacist Support for Delivery of Pharmacogenetic Testing

et al. 2017

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Aim. To investigate provider utilization of pharmacist support in the delivery of pharmacogenetic testing in a primary care setting. Methods. Two primary care clinics within Duke University Health System participated in the study between December 2012 and July 2013. One clinic was provided with an in-house pharmacist and the second clinic had an on-call pharmacist. Results: Providers in the in-house pharmacist arm consulted with the pharmacist for 13 of 15 cases, or about one of every four patients tested compared with one of every 7.5 patients in the on-call pharmacist arm. A total of 63 tests were ordered, 48 by providers in the pharmacist-in-house arm. Conclusion: These findings suggest that the availability of an in-house pharmacist increases the likelihood of pharmacogenetic test utilization.

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“…136,137 Moreover, clinical pharmacist interventions have been measured by using the MAI. 134,138 For ambulatory elderly patients taking an average of 7.9 drugs, the average MAI score/drug was 2.2 and total MAI/patient was 17.7. 134 After 3 months, there was a 24% improvement (decrease of 4.3 points from baseline, p=0.0006) in total MAI scores for patients randomly assigned to receive a clinical pharmacist intervention.…”

Section: Pharmacotherapy Assessmentsmentioning

confidence: 99%

“…134,138 For ambulatory elderly patients taking an average of 7.9 drugs, the average MAI score/drug was 2.2 and total MAI/patient was 17.7. 134 After 3 months, there was a 24% improvement (decrease of 4.3 points from baseline, p=0.0006) in total MAI scores for patients randomly assigned to receive a clinical pharmacist intervention. The most improvement occurred with corrected and more practical directions, changing therapy duration, and ensuring appropriate indications for existing drugs.…”

Section: Pharmacotherapy Assessmentsmentioning

confidence: 99%

Pharmacy Practice, Research, Education, and Advocacy for Older Adults

et al. 2005

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In the United States, older adults have become the fastest growing segment of the population and are expected to double in number to 70 million by 2030. As a whole, older adults have different health care needs than younger patients, and some of these needs should be met by pharmacists. Clinical pharmacy practice affecting older adults occurs in a variety of settings, including community, ambulatory care, primary care, hospital, assisted living, nursing home, home health care, hospice, and Alzheimer's disease units. Although specialty training in geriatrics or gerontology is not required for pharmacists to care for older adults, it is extremely helpful. Pharmacy education related to the care of older adults has improved slightly in the past several years but will need to increase even more to provide all pharmacists with the basic skills and knowledge to care for this unique group of patients. In addition, pharmacotherapy research targeting older adults needs to increase. Although it can be challenging, funding for this type of research is available. Patient and political advocacy is also important to support this growing population.

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A randomized, controlled trial of a clinical pharmacist intervention to improve inappropriate prescribing in elderly outpatients with polypharmacy

Cited by 537 publications

References 38 publications

A Prospective Trial of a Clinical Pharmacy Intervention in a Primary Care Practice in a Capitated Payment System

A Prospective Trial of a Clinical Pharmacy Intervention in a Primary Care Practice in a Capitated Payment System

Primary Care Providers’ Use of Pharmacist Support for Delivery of Pharmacogenetic Testing

Pharmacy Practice, Research, Education, and Advocacy for Older Adults

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