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3.
Artigo em Inglês | MEDLINE | ID: mdl-31426382

RESUMO

This systematic review examined the varied studies that have assessed the economic impact of pharmacist-participated medication management for nursing home residents older than 65 years of age. The articles published during 1990-2017 were found through PubMed, EMBASE and Ovid Medline. After the selection process by independent reviewers, a total of 12 studies were included. The quality of the selected articles was assessed using the Effective Public Health Practice Project checklist for economic studies. The articles were highly heterogeneous in terms of study design, pharmacist participation type, and measures of economic outcome. Therefore, the results are presented narratively according to the type of pharmacist involvement featured in the articles: interprofessional networks, interprofessional coordination, or interprofessional teamwork. Of the eight studies performing statistical comparison analyses, one study of interprofessional coordination and three of interprofessional teamwork showed statistically significant positive economic outcomes. The remaining four studies showed non-significant tendencies towards favorable economic outcomes. This review provides insights into the essential features of successful pharmacist-participated medication management for elderly patients in nursing homes.


Assuntos
Conduta do Tratamento Medicamentoso/economia , Casas de Saúde/economia , Farmacêuticos/economia , Idoso , Humanos
4.
J Manag Care Spec Pharm ; 25(9): 984-988, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31456492

RESUMO

BACKGROUND: This study summarizes the potential financial impact of a 3-year collaboration focused on delivering disease management services through pharmacies in 12 rural Colorado communities. OBJECTIVES: To (a) identify components within the disease management program that would be billable and generate revenue to each pharmacy and (b) estimate the revenue amount that could be generated based on these services across the 3-year project. METHODS: Reimbursable services included diabetes self-management education; medication therapy management services, including the comprehensive medication review; and improvements in Medicare star ratings through pharmacy interventions. RESULTS: An estimated total of $117,800 could have been generated by services provided to patients across the 12 pharmacy sites. After subtracting the estimated cost of labor for a pharmacist to provide these services, an estimated net profit of $60,023 resulted over 3 years. Star rating impacts were discussed but were not able to be included as specific revenue based on the complex contracting between pharmacies and third-party insurers. CONCLUSIONS: Based on these estimates, delivery of chronic disease management could represent a financially feasible option for community pharmacists. Some credentialing and changes to the mode of delivery would be required to meet billing requirements. Further research is needed to better estimate the cost savings resulting from these services to possibly expand pharmacists' reimbursement opportunities. DISCLOSURES: This publication was supported by Cooperative Agreement Number DP004796-05, funded by the Centers for Disease Control and Prevention. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services. None of the authors have any conflicts of interest to disclose regarding this work.


Assuntos
Serviços Comunitários de Farmácia/economia , Conduta do Tratamento Medicamentoso/economia , Farmácias/economia , Farmacêuticos/economia , Colorado , Redução de Custos/economia , Gerenciamento Clínico , Humanos , Medicare/economia , Adesão à Medicação , Estados Unidos
6.
Am J Health Syst Pharm ; 76(12): 874-887, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31361855

RESUMO

PURPOSE: Pharmacists are accountable for medication-related services provided to patients. As payment models transition from reimbursement for volume to reimbursement for value, pharmacy departments must demonstrate improvements in patient care outcomes and quality measure performance. The transition begins with an awareness of quality measures for which pharmacists and pharmacy personnel can demonstrate accountability across the continuum of care. The objective of the Pharmacy Accountability Measures (PAM) Work Group is to identify measures for which pharmacy departments can and should assume accountability. SUMMARY: The National Quality Forum (NQF) Quality Positioning System (QPS) was queried for NQF-endorsed medication-related measures. Included measures were curated into a data set of 6 therapeutic categories: antithrombotic safety, cardiovascular control, glucose control, pain management, behavioral health, and antimicrobial stewardship. Subject matter expert (SME) panels assigned to each area analyzed each measure according to a predetermined ranking system developed by the PAM Work Group. Measures remaining after SME review were disseminated during a public comment period for review and ballot. Over 1,000 measures are captured in the NQF QPS; 656 of the measures were found to be endorsed and medication use related or impacted by medication management services. A single reviewer categorized 140 measures into therapeutic categories for SME review; the remaining measures were unrelated to those clinical domains. The SME groups identified 28 measures for inclusion. CONCLUSION: An understanding of the endorsed quality measures available for public reporting programs provides an opportunity for pharmacists to demonstrate accountability for performance, thus improving quality and safety and demonstrating value of care provided.


Assuntos
Conduta do Tratamento Medicamentoso/organização & administração , Assistência Farmacêutica/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/normas , /economia , Humanos , Conduta do Tratamento Medicamentoso/economia , Conduta do Tratamento Medicamentoso/normas , Assistência Farmacêutica/economia , Assistência Farmacêutica/normas , Farmacêuticos/economia , Farmacêuticos/organização & administração , Farmacêuticos/psicologia , /normas , Papel Profissional/psicologia , Garantia da Qualidade dos Cuidados de Saúde/economia , Reembolso de Incentivo/economia , Reembolso de Incentivo/normas , Responsabilidade Social , Estados Unidos
7.
J Manag Care Spec Pharm ; 25(8): 898-903, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31347982

RESUMO

BACKGROUND: Low rates of beneficiary participation in medication therapy management (MTM) programs may be partly due to lack of awareness and understanding of the MTM program. To address this, the Centers for Medicare & Medicaid Services (CMS) requires Medicare Part D sponsors to provide online information about their MTM programs. An early study conducted in 2014 found low compliance rates, with only 59.5% of a small convenience sample of Part D plan contract websites compliant with CMS requirements. The current study provides a more recent evaluation of compliance with website requirements using a random sample of Part D plan contracts. OBJECTIVES: To (a) evaluate Part D sponsors' compliance with MTM program website elements that are required and suggested by CMS and (b) investigate the use of elements recommended by the National Institute on Aging (NIA) for websites for older adults. METHODS: A random sample of 184 Part D plan contract MTM program websites was selected from a list of 624 approved Part D plan contracts for 2016. Duplicate and inaccessible websites were excluded. The remaining websites were reviewed to determine compliance with CMS-required, CMS-suggested, and NIA-recommended elements. Descriptive statistics were reported at the Part D contract level for compliance with individual elements, category elements (CMS-required, CMS-suggested, and NIA-recommended), and overall compliance. Overall compliance by category was also reported by Part D plan type. RESULTS: Of the 184 MTM websites that were reviewed, 106 remained after excluding duplicate (n = 67) and inaccessible (n = 11) websites: 81 from Medicare Advantage prescription drug (MAPD) plans, 16 from prescription drug plans (PDPs), and 9 from Medicare-Medicaid plans (MMPs). Overall, 51% of Part D plan contract MTM websites were compliant with all of the 14 CMS-required elements. The only element in the CMS-suggested elements category, "accessibility by clicking through a maximum of two links," had a compliance rate of 79%. For the NIA-recommended elements category, 46% of the Part D plan contract MTM websites were compliant with the 4 elements. CONCLUSIONS: Medicare Part D plan sponsors are providing information about their MTM programs on plan websites. However, only 51% of Part D plan websites are fully compliant with CMS guidance, providing all required elements. DISCLOSURES: No outside funding supported this study. The authors have no financial or other relationships to disclose. The original research on a small and nonrandom sample of Part D plan contracts was presented during AMCP Nexus 2014; October 7-10, 2014; in Boston, MA. The results presented here are a larger and random sample of Part D plan contracts.


Assuntos
Medicare Part D/economia , Conduta do Tratamento Medicamentoso/economia , Adulto , Feminino , Humanos , Internet/economia , Masculino , Medicare Part C/economia , Assistência Farmacêutica/economia , Medicamentos sob Prescrição/economia , Estados Unidos
8.
J Manag Care Spec Pharm ; 25(6): 688-695, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31134865

RESUMO

BACKGROUND: Medication therapy management (MTM) programs are designed to improve clinical outcomes and enhance appropriate medication use. Comprehensive medication reviews (CMRs) and targeted medication reviews (TMRs) are 2 broad interventions defined within MTM services. While MTM services have been extensively researched, there are few comparisons of CMR versus non-CMR interventions. Given the variability in MTM interventions and lack of a consistent TMR definition in the literature, this study sought to compare CMRs and TMRs that were clearly defined based on Centers for Medicare & Medicaid Services (CMS) criteria. OBJECTIVES: To (a) compare acute inpatient admissions and emergency department (ED) visits between patients participating in MTM services (CMR, TMR, or both) and eligible nonparticipating patients and (b) examine the effect of receiving TMR services on medication adherence. METHODS: This was a retrospective cohort study of patients with Medicare Part D coverage who received MTM services and a 1:1 propensity score-matched control group. Participants had to be eligible for MTM services in 2014 or 2015 based on CMS requirements. CMRs were offered to all MTM-eligible patients, while TMRs were completed based on clinical rules that helped identify medication-related problems (MRPs). The date of MTM intervention, or eligibility for the control group, was considered the index date. Participants had to be continuously enrolled in a Medicare Advantage plan that included prescription drug coverage during the study period and have at least 6 months of data before and after the index date. Medical and pharmacy claims were assessed to examine trend-adjusted inpatient admissions and ED visits from pre-index to post-index date for participants and matched controls. RESULTS: In 2014 and 2015, receipt of TMR interventions was associated with statistically significant reductions in acute inpatient admissions. In 2014, there were 55.2 fewer admits per 1,000 individuals (95% CI = 29-81) and 30.8 fewer admits per 1,000 individuals in 2015 (95% CI = 20-42). Receipt of CMR-only interventions was associated with fewer acute inpatient admissions only when coupled with preidentification of MRPs (36.8 [95% CI = 25-49] fewer admits per 1,000 individuals). In 2015, there were significant reductions in ED visits for participants receiving TMR-only interventions or TMR/CMR interventions (26.1 [95% CI = 11-41] and 12.0 [95% CI = 1-23] fewer ED visits per 1,000 individuals, respectively). In both years, a larger percentage (0.4% for oral diabetes medications; 7.7% for antihypertensives; 3.0% for statins) of MTM participants had greater improvements in medication adherence in the post-index period compared with controls. CONCLUSIONS: Receiving MTM services targeted at resolution of MRPs (TMR or CMR/TMR) resulted in positive reductions in health care utilization and increases in medication adherence. Given the importance of optimal medication utilization, this study highlights the need for additional focus on resolution of MRPs through TMRs and CMRs that can support improved clinical outcomes. DISCLOSURES: No outside funding supported this study. Researchers completed the work as part of their employment with Humana. All authors are or were employees of Humana at the time of the study. There are no other conflicts of interest to disclose. This study was previously presented at AMCP Nexus 2017 on October 16, 2017, in Dallas, TX.


Assuntos
Medicare Part D/estatística & dados numéricos , Adesão à Medicação/estatística & dados numéricos , Conduta do Tratamento Medicamentoso/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Farmácias/organização & administração , Idoso , Idoso de 80 Anos ou mais , Uso de Medicamentos/economia , Uso de Medicamentos/estatística & dados numéricos , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Medicare Part D/economia , Conduta do Tratamento Medicamentoso/economia , Pessoa de Meia-Idade , Admissão do Paciente/economia , Admissão do Paciente/estatística & dados numéricos , Farmácias/economia , Farmácias/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos
9.
Intellect Dev Disabil ; 57(3): 234-241, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31120407

RESUMO

Nonelderly disabled Medicare beneficiaries have a higher prevalence of chronic conditions, higher utilization of prescription medications, and increased demand for clinical services when compared to beneficiaries 65 years of age and older who are not disabled. Out-of-pocket costs and medication-related problems are major barriers to medication compliance and achievement of therapeutic goals. A school of pharmacy partnered with a nonprofit organization that provides care to individuals with developmental disabilities. The present study highlights outcomes resulting from (a) providing Medicare Part D plan optimization services to lower prescription drug costs and (b) Medication Therapy Management services to evaluate safe and effective medication use in this beneficiary population. Provided interventions were shown to reduce overall medication costs and identify significant medication-related problems.


Assuntos
Deficiências do Desenvolvimento/economia , Gastos em Saúde , Medicare Part D/economia , Medicamentos sob Prescrição/economia , Adulto , Idoso , Redução de Custos , Deficiências do Desenvolvimento/tratamento farmacológico , Custos de Medicamentos , Feminino , Humanos , Benefícios do Seguro/economia , Masculino , Conduta do Tratamento Medicamentoso/economia , Pessoa de Meia-Idade , Projetos Piloto , Estados Unidos
10.
J Manag Care Spec Pharm ; 25(5): 573-577, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31039057

RESUMO

BACKGROUND: Mismanaged polypharmacy among older adults costs the health care system approximately $2 billion each year. Medication therapy management (MTM), a service designed to optimize medication use, improve health outcomes, and reduce associated costs, is available to eligible Medicare beneficiaries. Yet, it remains unclear which beneficiaries benefit most from this service. OBJECTIVE: To assess associations between patient characteristics, chronic disease, polypharmacy, and medication-related problems (MRPs) in a sample population of Medicare beneficiaries. METHODS: This study was a retrospective cross-sectional analysis of 1 Medicare Part D plan provider for the year 2015. Medicare beneficiaries were included if they were eligible to receive MTM services and excluded if they were aged under 65 years or the dataset had no count of MRPs for the beneficiary. A negative binomial regression assessed the relationship between age, sex, and chronic health conditions with MRPs. Second and third negative binomial regressions assessed the relationship between age, sex, and polypharmacy with MRPs. RESULTS: A sample of 27,765 Medicare beneficiaries had a mean (SD) age of 76 (±7) years, were predominantly female (59%), and used a mean (SD) of 11 (±4) chronic medications. Beneficiaries with certain conditions were more likely to incur an MRP than those without, including depression (OR = 1.58; 95% CI = 1.51-1.64), congestive heart failure (OR = 1.26; 95% CI = 1.20-1.31), diabetes (OR = 1.24; 95% CI = 1.18-1.29), end-stage renal disease (OR = 1.38; 95% CI = 1.25-1.52), respiratory conditions (OR = 1.25; 95% CI = 1.19-1.31), and hypertension (OR = 1.09; 95% CI = 1.01-1.18). Medicare beneficiaries with polypharmacy (11 or more medications) were 1.86 (95% CI = 1.80-1.93) times more likely to experience an MRP than those taking fewer medications. For every additional medication, the odds of incurring an MRP increased by 10% (OR = 1.11; 95% CI = 1.10-1.1.11). CONCLUSIONS: The diagnosis of depression presented with the strongest association with MRPs. Diabetes, congestive heart failure, end-stage renal disease, respiratory conditions, and hypertension also presented with significant associations with MRPs. Beneficiaries with polypharmacy (11 or more medications) were almost 2 times more likely to experience an MRP than those taking fewer medications. Addition of a chronic medication resulted in a 10% increase in the odds of incurring an MRP. MTM programs may find a greater number of MRPs among those diagnosed with depression in their MTM-eligible patient populations. DISCLOSURES: No outside funding supported this research. Silva Almodóvar reports fees from SinfoniaRx, outside the submitted work. Nahata has nothing to disclose.


Assuntos
Doença Crônica/tratamento farmacológico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/economia , Medicare Part D/economia , Conduta do Tratamento Medicamentoso/organização & administração , Polimedicação , Idoso , Idoso de 80 Anos ou mais , Doença Crônica/economia , Doença Crônica/epidemiologia , Estudos Transversais , Conjuntos de Dados como Assunto , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Masculino , Medicare Part D/estatística & dados numéricos , Conduta do Tratamento Medicamentoso/economia , Prevalência , Melhoria de Qualidade , Estudos Retrospectivos , Estados Unidos/epidemiologia
11.
Postgrad Med ; 131(5): 335-341, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31081414

RESUMO

Non-medical switching of medication, whereby a patient's treatment regimen is changed for reasons other than efficacy, side effects, or adherence, is often related to drug formulary changes aimed at reducing drug costs. In the era of health care reform, while cost-cutting measures are important, there is considerable evidence that non-medical switching, particularly when applied to medication used to treat chronic conditions such as diabetes, may impact patient outcomes, medication-taking behavior, and use of health care services. Ultimately, overall costs may be increased, as savings by insurers are cancelled out by higher costs to the health care system as a whole, such as extra administration, treatment failure from new medicines, and increased adverse events. The emergence of biosimilar and follow-on biologic treatments raises further questions among patients receiving biologic treatments, with patient advocacy groups calling for clear legislation to ensure that patients with complex or chronic conditions continue to receive effective, evidence-based medications for their disease. This article will discuss non-medical switching in the US, taking into account the different parties involved, such as patients, health care providers, pharmacists, payers, and pharmacy benefit managers, with the aim of providing a detailed overview of this complex and evolving topic.


Assuntos
Substituição de Medicamentos/estatística & dados numéricos , Medicamentos Genéricos/uso terapêutico , Custos de Cuidados de Saúde/estatística & dados numéricos , Conduta do Tratamento Medicamentoso/organização & administração , Medicamentos sob Prescrição/uso terapêutico , Substituição de Medicamentos/economia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/economia , Medicamentos Genéricos/economia , Humanos , Seguro de Serviços Farmacêuticos/estatística & dados numéricos , Conduta do Tratamento Medicamentoso/economia , Medicamentos sob Prescrição/economia , Estados Unidos
12.
Mayo Clin Proc ; 94(4): 660-669, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30737057

RESUMO

The 2013 American College of Cardiology/American Heart Association guideline on the treatment of blood cholesterol was a landmark document guiding health care professionals around the globe on how to administer lipid-lowering therapies. Those guidelines were primarily focused on statin therapy benefit groups. The writing committee found insufficient evidence for specific low-density lipoprotein cholesterol (LDL-C) treatment targets. There have been many important updates in the lipid literature since the publication of that document. Most importantly, clinical trials have provided definitive evidence for the pivotal role of LDL-C in atherogenesis and the improvement in clinical outcomes by means of aggressive LDL-C reduction. Ezetimibe, evolocumab, and alirocumab treatment resulted in substantial reductions in major adverse cardiovascular outcomes. These data encourage a discussion on whether LDL-C targets are warranted in primary and/or secondary prevention, and if so, how low should those targets be. In order to answer such questions, the costs and safety of such therapies, as well as the safety of very low levels of LDL-C need to be addressed. This review discusses the relationship between LDL-C lowering and cardiovascular risk reduction, the efficacy, safety, and cost-effectiveness of high-intensity lipid-lowering therapies, and the recommendations from the most recent lipid guidelines.


Assuntos
Anticolesterolemiantes/economia , Análise Custo-Benefício , Hipercolesterolemia/tratamento farmacológico , Hipercolesterolemia/economia , Conduta do Tratamento Medicamentoso/economia , Anticolesterolemiantes/uso terapêutico , Cardiologia/economia , Doenças Cardiovasculares/tratamento farmacológico , Doenças Cardiovasculares/economia , LDL-Colesterol , Humanos , Estados Unidos
13.
BMC Health Serv Res ; 19(1): 15, 2019 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-30621697

RESUMO

BACKGROUND: The implementation of an innovative and sustainable professional pharmacy service in routine care requires substantial resources borne by the pharmacy owner. Although a community pharmacy is a business setting, few studies have examined cost as a potential barrier to widespread implementation. Implementation costs, as the cost impact of an implementation effort, can be significant and hamper the decision to invest from the provider perspective. Traditional financial planning tools can be used to analyse and support business decision to implement a service by assessing the net impact of a new service on the provider's budget. This study aimed to estimate the implementation costs and the break-even point of an interprofessional medication adherence program for chronic patients in Switzerland. The program combines motivational interviews, medication adherence electronic monitoring and feedback reports to patient and physicians. METHODS: We used a 3-step approach: (i) micro-costing analysis: identification of implementation activities, quantification and valuation of required resources. Implementation costs, including service support costs and direct delivery costs, were analysed according to the implementation phase (installation, initial implementation, and full operation); (ii) break-even analysis: estimation of the required number of patients to follow up with to ensure that the generated revenue exceeded the total cost; and (iii) univariate sensitivity analyses. RESULTS: The estimated total cost of the installation phase was 8481 CHF, more than half of which represented the cost of the equipment. Direct delivery costs were 666 CHF per patient per year, with 68% of this value associated with the cost of workforce time. According to the Swiss national reimbursement system, a minimal of 16 [10-27] patients was required to cover the implementation costs of the installation phase. This break-even point decreased to 13 patients in the initial and full operation phases. CONCLUSIONS: These estimates lead to a better understanding of the real cost of implementing a professional pharmacy service in routine care. In a Swiss context, the current medication adherence support fee-for-service system allows pharmacists to reach the break-even point. Such information is important for community pharmacists to guide their implementation strategies. The replication of similar analyses in other settings and countries is paramount.


Assuntos
Doença Crônica/economia , Serviços Comunitários de Farmácia/economia , Adesão à Medicação/estatística & dados numéricos , Conduta do Tratamento Medicamentoso/economia , Desenvolvimento de Programas/economia , Serviços Comunitários de Farmácia/organização & administração , Custos de Cuidados de Saúde , Recursos em Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Relações Interprofissionais , Conduta do Tratamento Medicamentoso/organização & administração , Farmacêuticos , Médicos , Suíça
14.
Ther Innov Regul Sci ; 53(1): 95-99, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29714597

RESUMO

BACKGROUND: Pharmacists are the part of the health care team who can counsel patients on the most appropriate use of medications. This study aims to measure patients' experience with services provided by community pharmacists and their perceptions toward providing medication therapy management (MTM) services by community pharmacists in the Western Region of Saudi Arabia. In addition, this study aims to measure patients' willingness to pay (WTP) for participating in the MTM program led by community pharmacists. METHODS: Using a cross-sectional research design, a prevalidated questionnaire was developed and posted to respondents through either face-to-face interviews or online social media. All data were analyzed using SPSS, version 22.0, and all alpha values less than 0.05 were considered significant. RESULTS: A total of 953 responses were obtained in this study. Overall, 47.6% of the respondents always buy their medications from different community pharmacies, and 46.1% of respondents said that community pharmacists always respond to all of their questions. In addition, 96% of respondents perceived the MTM program to be beneficial for patient care. Moreover, 70.3% of respondents were willing to register in the MTM program if implemented at community pharmacies. CONCLUSION: Residents in the Western Region of Saudi Arabia highly appreciate the additional values of the MTM program if implemented by community pharmacists. Decisions makers should encourage community pharmacists to plan for MTM services.


Assuntos
Serviços Comunitários de Farmácia/organização & administração , Conduta do Tratamento Medicamentoso , Adolescente , Adulto , Feminino , Humanos , Masculino , Conduta do Tratamento Medicamentoso/economia , Percepção , Farmacêuticos , Arábia Saudita , Inquéritos e Questionários , Adulto Jovem
15.
J Manag Care Spec Pharm ; 24(12): 1278-1283, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30479196

RESUMO

INTRODUCTION: As value-based and alternative payment models proliferate, there is growing interest in measuring pharmacy performance. However, little research has explored the development and implementation of systems to measure pharmacy performance. Additionally, systems that currently exist rely on process and surrogate outcome measures that are not always relevant to patients and payers. PROGRAM DESCRIPTION: This article describes the process used to design and implement a performance measurement program for a group of enhanced services pharmacies in North Carolina. This program was successful in measuring quality based on medication adherence, hospitalizations, emergency department visits, and total cost of medical care for nearly all North Carolina pharmacies. Measures were scored and combined into a single 11-point composite pharmacy performance score. To demonstrate the measures, we compared performance scores for enhanced services pharmacies (n = 119) to other North Carolina pharmacies (n = 1,616) during the baseline measurement period (March 1, 2015-May 31, 2015). Adherence measure scores for enhanced services pharmacies exceeded those of other pharmacies (P values < 0.0001-0.003), but total scores were not significantly different, with enhanced services pharmacy mean total scores of 6.54 vs. 6.29 for all other pharmacies (P = 0.115). OBSERVATIONS: The program described provides an example of a composite performance measurement system that can be used to support alternative pharmacy payment models and shows that case-mix adjustment is possible for broad outcomes such as those used in this program. The measures used for the program depend on timely feeds of medical claims. Payers and pharmacy networks implementing a similar program may need to explore alternative structure or process measures. IMPLICATIONS: As pharmacy payment models evolve, there may be value in collaboration between academics, pharmacists, and payers to bring different areas of expertise and perspectives into the performance measurement process. This program demonstrates that global outcome measurement is possible over a broad set of pharmacies and invites additional research to explore the validity of this and other methods to measure pharmacy quality and performance. DISCLOSURES: The program described in this article was supported by Funding Opportunity Number 1C12013003897 from the U.S Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies. Community Care of North Carolina received the grant and subcontracted with the UNC Eshelman School of Pharmacy to carry out this project. Shasky, Pfeiffenberger, and Trygstad are employed by Community Care of North Carolina. Urick and Ferreri are employed by the UNC Eshelman School of Pharmacy. Farley was employed by the UNC Eshelman School of Pharmacy during data collection for this project and reports consulting fees from UCB Pharmaceutical Company unrelated to this project. Pfeiffenberger reports membership on the Pharmacy Quality Alliance (PQA) task force on pharmacy level measures; Trygstad is a PQA board member; Urick is a member of a scientific advisory committee for PQA.


Assuntos
Serviços Comunitários de Farmácia/organização & administração , Conduta do Tratamento Medicamentoso/organização & administração , /métodos , Serviços Comunitários de Farmácia/economia , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Adesão à Medicação/estatística & dados numéricos , Conduta do Tratamento Medicamentoso/economia , North Carolina , Farmacêuticos/economia , Farmacêuticos/organização & administração , Avaliação de Programas e Projetos de Saúde
16.
J Manag Care Spec Pharm ; 24(12): 1264-1268, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30479198

RESUMO

INTRODUCTION: In a time of evolving health care landscapes, pharmacists who provide comprehensive medication management (CMM) need to demonstrate financial and quality value to sustain their practice. Minnesota CMM programs started providing services in 1998, before recognition or reimbursement existed, and continue practices today. This long history lends itself well to the development of best practices for sustaining CMM practices. PROGRAM DESCRIPTION: The Health-Systems for Integrated Medication Management (HAIMM) represents 13 Minnesota health systems, including 90 pharmacists and 121 clinics across the state. Pharmacist representatives from each of the participating health systems were polled to determine commonly implemented sustainability strategies. Common trends were identified, and the group was surveyed for important considerations on implementation of each strategy. OBSERVATIONS: Poll results of strategies for CMM practice sustainability were placed into 2 categories: fiscal and quality-based initiatives. Each strategy was discussed to determine implementation options and lessons learned from the collaborative. IMPLICATIONS: Numerous strategies were identified to ensure CMM practice sustainability. HAIMM's programs found it best to use a mixture of fiscal and quality-based strategies to sustain their practices. DISCLOSURES: No outside funding supported this study. The authors have no conflicts of interest to declare. The information within this article should not be construed as legal advice, and the Health-Systems Alliance for Integrated Medication Management (HAIMM) disclaims all liability of action or lack of action resulting from use of this content. Readers should obtain legal and/or professional advice from a licensed professional within their state.


Assuntos
Colaboração Intersetorial , Conduta do Tratamento Medicamentoso/organização & administração , Farmacêuticos/organização & administração , Atenção Primária à Saúde/organização & administração , Desenvolvimento Sustentável/tendências , Redução de Custos , Humanos , Conduta do Tratamento Medicamentoso/economia , Conduta do Tratamento Medicamentoso/tendências , Minnesota , Farmacêuticos/tendências , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/tendências , Papel Profissional , Avaliação de Programas e Projetos de Saúde , Desenvolvimento Sustentável/economia
17.
Am J Health Syst Pharm ; 75(22): 1805-1811, 2018 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-30104259

RESUMO

PURPOSE: The implementation and delivery of a pharmacist-led chronic care management (CCM) service in a geriatric primary care clinic are described. METHODS: A CCM service was provided March 1 through December 31, 2016, at the University of Colorado Hospital Seniors Clinic ("Seniors Clinic"). The electronic health record (EHR) team for the University of Colorado Health system developed a patient registry through EPIC Healthy Planet (Epic Systems Corp., Verona, WI) to identify patients at the Seniors Clinic eligible for CCM services. The EHR team constructed a note type and documentation template within the EHR to ensure documentation of all necessary components for billing and to allow individual clinical staff to document the time spent providing CCM care. RESULTS: Overall, 36 elderly patients enrolled in the pharmacist-provided CCM service over the 10 months. Clinical pharmacists spent a total of 156-849 minutes per month providing CCM services, with a mean outreach time of 45.4 minutes per patient. The clinical pharmacists submitted 95 claims, and all but 5 were paid. The total amount reimbursed from the health plans during the 10 months was $2,775.02. CONCLUSION: Medicare patients were successfully enrolled in a CCM service in a geriatrics primary care clinic led by clinical pharmacists and medical providers. The CCM services were more time-consuming than the allotted 20 minutes per patient per month with the CCM Current Procedural Terminology code used during this study.


Assuntos
Instituições de Assistência Ambulatorial , Serviços de Saúde para Idosos , Farmacêuticos , Idoso , Idoso de 80 Anos ou mais , Instituições de Assistência Ambulatorial/economia , Instituições de Assistência Ambulatorial/organização & administração , Colorado , Feminino , Serviços de Saúde para Idosos/economia , Serviços de Saúde para Idosos/organização & administração , Financiamento da Assistência à Saúde , Humanos , Masculino , Medicare , Conduta do Tratamento Medicamentoso/economia , Conduta do Tratamento Medicamentoso/organização & administração , Papel Profissional , Estados Unidos
18.
J Am Pharm Assoc (2003) ; 58(5): 485-491, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30033127

RESUMO

OBJECTIVES: The market for chronic hepatitis C (HCV) treatment has changed rapidly. New treatments offer high cure rates, fewer adverse effects, and shorter treatments-but also increased costs per therapy. The objective of this study was to compare adherence and cost between HCV patients included in an enhanced prior authorization and management program (PAMP) versus no intervention in Medicaid members undergoing treatment. DESIGN: A retrospective study using longitudinal panel data assessed differences in adherence and costs associated with implementation of the PAMP from the payer perspective. The PAMP included case management, patient education, pharmacy counseling, and medication adherence. Multivariable generalized estimating equations were used to assess associations between program and outcomes. SETTING AND PARTICIPANTS: Patients with HCV enrolled in a state Medicaid program receiving or requesting HCV treatment from January 2014 to November 2015. OUTCOME MEASURES: Outcomes included medication adherence, treatment gaps, and pharmacy and total direct costs after controlling for demographic and clinical factors between those in the PAMP and those in the preintervention period. RESULTS: There were 384 Medicaid members included (156 pre-PAMP, 228 post-PAMP). Overall adherence was high regardless of PAMP intervention, although an adjusted 1.086-fold increase in medication possession ratio (MPR) was observed with the program and a 2.732-fold higher odds of adherence above 80% (P < 0.05). Members in the program had 0.358 times lower adjusted odds of a greater than 3-day treatment gap, and pharmacy-related costs were 0.940 times lower (P < 0.05); no difference was observed in total medical costs (P = 0.333). CONCLUSION: This enhanced Medicaid program was associated with increased adherence to HCV therapy, decreased treatment gaps, and decreased pharmacy-related costs compared with the preintervention period. Because challenges exist if patients fail HCV treatment or if viral resistance emerges, ensuring high adherence and persistence remains key. Continued work is needed to develop and assess enhanced management programs for this population.


Assuntos
Custos de Medicamentos/estatística & dados numéricos , Hepatite C Crônica/economia , Adesão à Medicação/estatística & dados numéricos , Conduta do Tratamento Medicamentoso/economia , Autorização Prévia/economia , Serviços Comunitários de Farmácia/economia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Farmacêuticos , Estudos Retrospectivos , Estados Unidos
19.
J Manag Care Spec Pharm ; 24(8): 813-818, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30058982

RESUMO

BACKGROUND: Pharmacist-delivered medication therapy management (MTM) services can improve patient outcomes, yet little is known about outpatient, interprofessional telepharmacy programs. OBJECTIVE: To evaluate an outpatient, interprofessional telehealth chronic care management (CCM) pilot program. METHODS: This 6-month program integrated family medicine providers, a university-based medication management telepharmacist, and an interprofessional care coordinator using telehealth solutions for CCM and pharmacy education services. A physician referred patients at risk for medicine-related problems to the telepharmacist. Eligible patients had 3 or more chronic conditions or took at least 5 medications, were aged 18 years and older, and had at least 1 appointment with their primary care provider during the program. The care coordinator met patients in person to facilitate these virtual clinic processes. The telepharmacist conducted a comprehensive medication review (CMR) via video-conferencing technology, providing CCM based on primary diagnosis, current medications and allergies, laboratory results, and previous chart notes. The consultation was documented in the electronic health record (EHR) for provider review and modification in real time. RESULTS: 69 patients received telepharmacy consultations and on-site registered nurse support during the program. Most patients were female (56.5%), aged 51-70 years (60.1%), Caucasian (72.4%), and non-Hispanic/Latino (71.0%). Patients had 1-9 chronic conditions, such as hypertension (82.6%), diabetes (56.5%), hyperlipidemia (31.9%), depression (30.4%), and osteoporosis (29.0%). Most patients (94.2%) took at least 5 chronic disease medications, such as statins (11.2%), nonsteroidal anti-inflammatory drugs (8.4%), selective serotonin reuptake inhibitors (6.5%), beta blockers (6.5%), and calcium channel blockers (5.6%). The telepharmacist completed 200 interventions for safety (49.0%), vaccines (24.5%), care gaps per national consensus guidelines (13.5%), adherence (10.0%), and cost savings (3.0%). Patients' providers accepted one third (n = 75, 37.5%) of the telepharmacist recommendations (e.g., monitoring and medication changes). CONCLUSIONS: This telehealth program constituted an added service for patients while simultaneously filling a gap in on-site pharmacist counseling services. Integrating the telepharmacist and registered nurse was crucial to clinical service provision. The results are encouraging; however, more research must examine the effectiveness of telehealth services in reaching underserved populations, improving patient care, and decreasing health care costs. DISCLOSURES: External funding from SinfonîaRx was used to help conduct this project. Boesen is employed by SinfonîaRx. At the time this project was conducted, Martin was employed at the University of Arizona Medication Management Center but is now employed by SinfonîaRx. The other authors have no disclosures to report. This original research was presented as a poster at the Academy of Managed Care Pharmacy Nexus 2015; October 26-29, 2015; in Orlando, FL.


Assuntos
Assistência Ambulatorial/organização & administração , Doença Crônica/tratamento farmacológico , Conduta do Tratamento Medicamentoso/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Telemedicina/organização & administração , Idoso , Assistência Ambulatorial/economia , Assistência Ambulatorial/métodos , Doença Crônica/economia , Serviços Comunitários de Farmácia/economia , Serviços Comunitários de Farmácia/organização & administração , Redução de Custos , Feminino , Custos de Cuidados de Saúde , Humanos , Masculino , Conduta do Tratamento Medicamentoso/economia , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente/economia , Farmacêuticos/economia , Farmacêuticos/organização & administração , Projetos Piloto , Encaminhamento e Consulta/economia , Encaminhamento e Consulta/organização & administração , Telemedicina/economia , Telemedicina/métodos
20.
J Manag Care Spec Pharm ; 24(8): 795-799, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30058987

RESUMO

BACKGROUND: Recent changes in the health care delivery landscape have expanded opportunities for clinical pharmacists in the ambulatory care setting. This article describes the successful integration of a clinical pharmacist-led chronic disease management service in a patient-centered medical home (PCMH) and accountable care organization (ACO) environment. PROGRAM DESCRIPTION: In 2008, the year before PCMH implementation, 36% of patients who were hospitalized at Advocate Trinity Hospital for a heart failure exacerbation were readmitted within 30 days of their hospital stay for heart failure exacerbation. This high rate of heart failure hospital readmissions, compared with national standards, drove the implementation of the PCMH at Advocate Medical Group - Southeast Center (AMG-SE), the adjoining outpatient medical clinic. A clinical pharmacist was added to the health care team to help achieve the collective goal of improving patient outcomes and decreasing hospitalizations. OBSERVATIONS: From November 1, 2009, through August 30, 2010, the clinical pharmacist conducted visits and intervened in the care of 111 chronic heart failure patients. A pre/post analysis of those 111 patients during the 10 months before and after the integration of the clinical pharmacist showed that those patients were hospitalized 63 times in the 10 months before having regularly scheduled visits with the clinical pharmacist and 30 times in the 10 months after establishing care. This reduction from 63 to 30 visits translated to an approximate 50% decrease in heart failure hospitalizations in patients being followed by the clinical pharmacist within the first 10 months. Once the clinical pharmacist became better integrated into the workflow through development of rapport with the medical team, the outcomes improved further. In an 18-month analysis from May 1, 2010, through November 30, 2011, only 2% of patients (3 of 153) designated as high-risk patients managed by the clinical pharmacist had a 30-day readmission for heart failure exacerbation. IMPLICATIONS: Outcomes-based models have expanded opportunities for clinical pharmacist involvement and can provide unique reimbursement options. Demonstration of cost savings and an improvement in quality measures are paramount to establishing and justifying the clinical pharmacist's role in a team-based model of care. DISCLOSURES: No outside funding supported this research. The authors have no conflicts of interest to disclose.


Assuntos
Insuficiência Cardíaca/tratamento farmacológico , Readmissão do Paciente/estatística & dados numéricos , Assistência Farmacêutica/organização & administração , Farmacêuticos/organização & administração , Papel Profissional , Organizações de Assistência Responsáveis/economia , Organizações de Assistência Responsáveis/organização & administração , Organizações de Assistência Responsáveis/estatística & dados numéricos , Assistência Ambulatorial/economia , Assistência Ambulatorial/organização & administração , Assistência Ambulatorial/estatística & dados numéricos , Redução de Custos , Humanos , Conduta do Tratamento Medicamentoso/economia , Conduta do Tratamento Medicamentoso/organização & administração , Conduta do Tratamento Medicamentoso/estatística & dados numéricos , Equipe de Assistência ao Paciente/organização & administração , Readmissão do Paciente/tendências , Assistência Centrada no Paciente/economia , Assistência Centrada no Paciente/organização & administração , Assistência Centrada no Paciente/estatística & dados numéricos , Assistência Farmacêutica/economia , Assistência Farmacêutica/estatística & dados numéricos , Farmacêuticos/economia , Farmacêuticos/estatística & dados numéricos , Planos de Incentivos Médicos/organização & administração , Planos de Incentivos Médicos/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Reembolso de Incentivo/organização & administração , Reembolso de Incentivo/estatística & dados numéricos
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