A systematic review of remuneration systems for clinical pharmacy care services

Abstract

Objective: To provide descriptions of existing remuneration models for pharmacist clinical care services and to summarize the existing evaluations of economic, clinical, and humanistic outcome studies of the remuneration models. Methods: We searched MEDLINE, EMBASE, International Pharmaceutical Abstracts, EconLit, Scopus, Web of Science, Google Scholar, and PubMed from date of inception to June 2006. We also searched the World Wide Web, hand-searched pertinent journals and reference lists, and contacted experts in pharmacy practice research. One reviewer assessed titles and, with a second independent reviewer, assessed abstracts and full-text articles for inclusion and abstracted data. Disagreements were resolved by discussion or by a third independent reviewer. We included English language articles that described or evaluated current remuneration systems for pharmacist clinical care services and that involved a substantial number of pharmacists and that were paid by a third party other than the patient. Due to heterogeneity between systems, data were compiled qualitatively. Then, based on these results, an expert panel developed recommendations for implementing a remuneration model into current pharmacy practice in Alberta. Results: We identified 28 remuneration systems. Most commonly, payers were government agencies, and services were directed at the management of chronic diseases or complex medication regimens. While capitation models were evident, most systems provided payment according to each intervention carried out. Program evaluations were available from 14 models, and in many systems, initial uptake by pharmacists was high, but participation dropped after initial enrolment. Conclusion: To ensure that the provision of clinical care services will provide a sustainable avenue of income for pharmacists and costeffective quality care for patients, a viable business model with additional training and support for pharmacists and ongoing program evaluation is needed.

Clinical medication review in Australia: A systematic review

“…87 However, other reviews have highlighted the benefits of colocation and the importance of collaboration between pharmacists, GPs and other staff, as well as patient involvement at all steps of the CMR process. 4,5,88 Although many early Australian studies that demonstrated the value of CMR included a follow-up case conference between the pharmacist and GP, anecdotal experience suggests this rarely occurs in practice. 24,34,37,45,49 This review found that CMRs are effective in optimizing a range of clinical outcomes, including disease-specific endpoints and hospitalizations.…”

“…52 Internationally, accreditation costs, insufficient remuneration, lack of consumer awareness, time constraints and rural locations were found to be significant barriers to the delivery of clinical pharmacy services. 88 On-going remuneration, increased numbers of accredited pharmacists, uptake, consumer and GP awareness, funding for interpreter services and directreferral pathways have been identified as mechanisms to ensure continued implementation and development of the program. 21,65,79 Methods to account for confounding in the design or analysis such as stratification or multivariable analyses were reported in only a quarter of studies, although this was not necessarily applicable in all studies.…”

A comparative analysis of remuneration models for pharmaceutical professional services

“…Since hospital pharmacists are providing PPS on the terms of the employer and since the extent to which they can influence the content, quantity and quality of the service is likely to vary, studies of PPS provided in hospital pharmacies were excluded. Since two previous studies covered the literature on PPS remuneration models until 2006 [12,13], our search focused mainly on articles and reports published after 2006.…”

Personality Traits of Hospital Pharmacists: Toward a Better Understanding of Factors Influencing Pharmacy Practice Change

“…[1][2][3] However, advancement toward this objective has been slow and incomplete. [4][5][6][7][8][9] For example, a survey conducted in 2007 found that the majority of pharmacist respondents spent their work time on dispensingrelated activities, although they were interested in and recognized the need for practice change. 7 British Columbia pharmacists have had the authority to adapt prescriptions since 2009 8 ; however, adapted prescriptions accounted for only 0.2% of all prescription claims in that year.…”