The Effectiveness of Collaborative Medicine Reviews in Delaying Time to Next Hospitalization for Patients With Heart Failure in the Practice Setting

Abstract

Background-Randomized controlled trials have demonstrated that collaborative medication reviews can improve outcomes for patients with heart failure. We aimed to determine whether these results translated into Australian practice, where collaborative reviews are nationally funded. Methods and Results-This retrospective cohort study using administrative claims data included veterans 65 years and older receiving bisoprolol, carvedilol, or metoprolol succinate for which prescribing physicians indicated treatment was for heart failure. We compared those exposed to a general practitioner-pharmacist collaborative home medication review with those who did not receive the service. The service includes physician referral, a home visit by an accredited pharmacist to identify medication-related problems, and a pharmacist report with follow-up undertaken by the physician. Kaplan-Meier analyses and Cox proportional hazards models were used to compare time until next hospitalization for heart failure between the exposed and unexposed groups. There were 273 veterans exposed to a home medicines review and 5444 unexposed patients. Average age in both groups was 81.6 years (no significant difference). The median number of comorbidities was 8 in the exposed group and 7 in the unexposed (PϽ0.0001). Unadjusted results showed a 37% reduction in rate of hospitalization for heart failure at any time (hazard ratio, 0.63; 95% CI, 0.44 to 0.89). Adjusted results showed a 45% reduction (hazard ratio, 0.55; 95% CI, 0.39 to 0.77) among those who had received a home medicines review compared with the unexposed patients. Conclusion-Medicines review in the practice setting is effective in delaying time to next hospitalization for heart failure in those treated with heart failure medicines. (Circ Heart Fail. 2009;2:424-428.)

An Elective Course in Differential Diagnostics

“…18 PharmD students receive instruction on pharmacotherapy pertaining to disease states affecting various systems and are expected to competently assign the best patient-specific treatment regimen to ensure the effective provision of comprehensive medication management, clinical consulting, and collaborative prescribing. [19][20][21][22][23][24][25][26] While not trained to be diagnosticians, throughout the curricula, PharmD students are introduced to didactic information and given assignments that require them to be familiar with the diagnostic tests ordered to diagnose many disease states. 18 In professional practice settings, pharmacist clinicians often must decide whether they should recommend prescription and/or nonprescription medications based on their patients' complaints 5,6,[11][12][13][14][15]17 Thus, pharmacists must be able to accurately assess a patient's presenting complaint and recommend the most appropriate course of action, a responsibility that places the pharmacist in a pivotal role with respect to the patient's health care.…”

“…[1][2][3][4][5][6][7][8]11,15,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] Programs training physicians, physician assistants, dentists, and other prescribers use similar educational methods as those used with PharmD students (ie, problem-based learning), yet there is less emphasis on the use of the principles of differential diagnostics in PharmD curricula, perhaps because pharmacists do not formally diagnose patients' ailments as part of their daily practice. To better prepare PharmD students to effectively interact with other healthcare providers and provide quality patient care, an elective course was developed focusing on problem-solving using the basic principles of differential diagnostics.…”

Time to Rethink the Funding Model for Home Medicines Review

“…MedsChecks, Diabetes MedsChecks and Clinical Interventions by pharmacists), none of which is supported by any evidence in the context of the Australian healthcare setting. Conversely, there is evidence on the value of HMRs to consumers, 2,5,6 a demonstration of cost savings of up to $550 per HMR to the health system, 7-10 and a demonstrable track record that clearly illustrates the delivery of a truly collaborative service between GPs, patients, independent accredited pharmacists and other community or hospitalbased pharmacists [11][12][13][14][15][16][17][18] (Fig. 1).…”

“…Australian studies have demonstrated that HMRs can resolve, manage or reduce medicine-related problems for a wide range of patients. [11][12][13][14][15][16][17][18][19][20][21] In addition, HMRs improve health outcomes; for example, in patients receiving betablockers for heart failure, an HMR resulted in a 45% reduction in likelihood of hospitalisation for heart failure at any time. 18 Another study found that an HMR in patients taking warfarin resulted in a 79% reduced likelihood of bleeding-associated hospitalisation 2-6 months after the HMR.…”

“…21 Research conducted across Australia has consistently demonstrated that HMRs are a cost-effective way to identify and resolve medicine-related problems and improve health outcomes. [11][12][13][14][15][16][17][18][19] Based on Australian data, [7][8][9][10][11][18][19][20] approximately 25 000 out of every 100 000 HMRs conducted are provided to patients with high-cost medical conditions (diabetes, heart failure and atrial fibrillation). Cost savings to the health system arising from HMRs for those 25 000 Australians can be estimated at approximately $550 per person for each HMR (from hospital costs and length of stay), totalling $13.75 million per year.…”