Reducing Health Care Costs and Improving Clinical Outcomes Using an Improved Asheville Project Model

Abstract

Relevance and Contribution to Literature: This study was designed to add to the body of knowledge gained through the original Asheville Project studies, and to address some of the limitations of the earlier studies. Scalability. Since the original Asheville Project publications there have been some successful replications, however, there is a need to broaden the geographic scope and increase the size of the study population. Study Design. Previous studies were limited to pre-post, self-as-control design. We added a control group. Model improvement. We were able to incorporate an electronic record of care. This allows incorporation of medical and prescription claims, ease of documentation, improved data capture, reporting, standardization of care, identification of deficiencies in care, and communication with other health care providers. This enhancement may be worthy of more comment than we devoted to it , however, we didn't want to detract from the main goal of the study, and we wanted to avoid any hint of commercialization on the part of the organization that provided the electronic record. Relevance to profession. We sincerely hope the relevance goes beyond the profession of pharmacy and that it reinforces the message that the profession of pharmacy offers real solutions to rising health care costs in the U.S.

Economic evaluations of pharmacist‐managed services in people with diabetes mellitus: a systematic review

“…Among them, 19 were conducted in the USA [5][6][7][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33], while each of the remaining studies was conducted in a different country: the UK [34], Bulgaria [35], Canada [36], Australia [37], Colombia [38] and Brazil [39]. Most of the studies were conducted in a community pharmacy (n = 10) [5,6,20,25,[28][29][30][35][36][37], or a clinic or hospitalbased outpatient facility (n = 8) [18,21,24,27,[31][32][33][34]. Two studies enrolled participants from various practice settings [7,22], while the remaining five studies did not delineate the practice settings [19,23,26,…”

“…Two studies enrolled participants from various practice settings [7,22], while the remaining five studies did not delineate the practice settings [19,23,26,38,39]. Ten articles were prospective single-group self-controlled studies [18,[20][21][22]24,26,28,32,34,35]; another 10 articles were prospective studies with concurrent control(s) [5][6][7]23,25,29,31,[37][38][39], five of which were randomized [5,25,31,37,38]. The remaining articles were retrospective concurrent-controlled studies (n = 2) [19,30], studies using economic models (n = 2) [33,36], and a retrospective single-group study with no comparison [27].…”

“…Eight studies had < 100 participants [5,20,26,30,32,34,35,39], 11 had 100-600 participants [6,18,21,22,24,25,27,28,31,37,38], and four had > 1000 participants [7,19,23,29]. Most of the studies were conducted over a period of ≤ 12 months (n = 14) [5,7,18,19,24,26,28,29,31,[34][35][36][37]39], whereas 10 studies had study durations ≥ 14 months [6,[20][21][22][23]25,30,32,33,38]. One study did not report the duration as it was still ongoing when published [27].…”

“…One study did not report the duration as it was still ongoing when published [27]. The pharmacist-managed services described in these studies can be grouped into one or a combination of the following five categories: targeted education (n = 24) [5][6][7][18][19][20][21][22][23][24][26][27][28][29][30][31][32][33][34][35][36][37][38][39]; general pharmacotherapeutic monitoring (e.g. medication review and modification, and making recommendations to other healthcare providers) (n = 21) [5,29,35,37]; health screening or laboratory testing services (n = 9) [18,20,21,24,27,33,34,36,38]; immunization services (n = 2) [24,33]; and pharmacokinetic monitoring (n = 1) [27].…”

“…Fourteen studies conducted a partial economic evaluation, such as outcome analysis (n = 12) [18,19,21,23,25,26,[28][29][30]32,38,39], cost analysis (n = 1) [31] and cost description (n = 1) [27]. Eleven studies were full economic evaluations, including cost-benefit analysis (n = 6) [7,20,22,24,35,36], cost-effectiveness analysis (n = 4) [5,6,34,37], and cost-utility analysis (n = 1) [33]. Thirteen studies were conducted from a payer's perspective [5,6,[20][21][22][23]26,[28][29][30]33,36,38], whereas the rest were conducted from a provider's perspective [7,18,19,24,25,27,31,32,34,35,…”