Consultant Pharmacist Drug Therapy Recommendations Acceptance and Rejection from Monthly Drug Regimen Reviews in a Geriatric Nursing Facility: Fourth Year Results and Cost Analysis

Abstract

Purpose To document and compare the outcomes from monthly drug regimen review recommendation acceptance and rejection in one skilled nursing facility by one consultant pharmacist (CP) in the fourth year of evaluation with the prior 3 years' data. Method A non-randomized, observational, prospective cohort study with all patients being residents for at least 30 days over the 12-month period (October 1, 1997 to September 30, 1998) in a skilled nursing facility with more than 100 beds. The admission problem-oriented records of all patients and their respective CP reports were screened for pharmacotherapy recommendations and subsequent acceptance and rejection on a monthly, repeated-measures basis for 12 months. There were 2,004 monthly drug regimen review (DRR) reports. The percentage of DRR reports that made recommendations was tabulated. Written recommendations made to attending physicians that were either accepted or rejected within 3 months were analyzed. The charges for adverse outcomes were calculated from billing records or prior studies of the outcome. These results were compared with prior 1- and 2-year studies of outcomes within the same setting. Carryover effects of recommendations implemented in prior periods were also calculated. Results There were 178 recommendations made in 2,004 DRR reports (8.9%). A low acceptance rate, 27 of 178 recommendations (15.2%), resulted and was combined with carryover of prior acceptance in a cost savings of $113,962. The 151 recommendations that were rejected resulted in $226,503 of presumed unnecessary costs to the health care system. A prior 2-year study of recommendations with an acceptance rate of 89% showed costs savings of $111,609 per year with acceptance and $112,297 added costs per year with 11% rejection. The first-year study had a 93% acceptance rate at a projected cost savings of $43,854 and costs increased by $60,825 with a 7% rejection. The costs of recommendation rejection in the fourth year were substantially higher, with a higher rejection rate than was seen in the prior 3 years of observation. Conclusion Documentation of the costs from CP intervention should factor in costs of rejection that may increase with the percentage rejection of recommendations, length of observation period, and may vary between facilities.

Economic Impact of Pharmacist-Participated Medication Management for Elderly Patients in Nursing Homes: A Systematic Review

“…Of the 12 articles, two studies were in the context of interprofessional networks [25,28], six in interprofessional coordination [23,24,26,29,33,34], and four in interprofessional teamwork [27,30,31,32]. The analytic methods of the cost outcomes varied; there were seven cost-minimization analyses [24,25,26,27,28,31,34], two cost–benefit analyses [23,29], two cost-effectiveness analyses [30,32], and one cost–utility analysis [33]. Regardless of the outcome type, the outcomes of all the studies were positive in direction or favorable.…”

“…Six studies investigated the economic impact of interprofessional coordination, which included pharmacist-led medication reviews of nursing home residents (Table 3) [23,24,26,29,33,34]. There were two observational cohorts [23,29], two cluster randomized controlled trials (RCTs) [24,26], one controlled clinical trial [33], and one before-and-after study [34].…”

Systematic review and narrative synthesis of pharmacist provided medicines optimisation services in care homes for older people to inform the development of a generic training or accreditation process

“…Table summarises the characteristics of the 59 included papers. The majority of studies were located in the United States, UK and Australia with smaller numbers from the Netherlands, Canada and Belgium . Twelve papers reported randomised controlled trials, and five were non‐randomised controlled studies, with the remainder pre‐/post‐uncontrolled interventions conducted as service evaluations.…”

“…Thirteen papers stated that the pharmacist delivering the service was a ‘consultant’, and twelve papers noted that the pharmacist was described as ‘clinical’ . Five papers reported that the pharmacist had completed an accreditation process, one of which described the training as consisting of consultation skills, identification of drug‐related problems, guidelines and how to create pharmaceutical care plans.…”

“…Although it was not a focus of this paper, a commonly reported outcome was the number of pharmacist interventions accepted and implemented by the responsible primary care physician . The reliance on another professional to accept and implement a pharmacist’s recommendations may partially explain the focus on the development of inter‐professional relationships within pharmacist training in two of the papers.…”