Identification of medication-related problems and health care provider acceptance of pharmacist recommendations in the DiabetesCARE program.

OBJECTIVES: To evaluate the efficacy of pharmacist recommendations to health care providers, as part of PharmacistCARE, a single-center, pharmacist-run, diabetes medication therapy management (MTM) service. If the recommendation was accepted, a secondary objective was to measure the length of time for acceptance. DESIGN: Prospective assessment. SETTING: University of Kentucky (UK), from March 2003 through December 2006. PATIENTS: 172 adult patients with diabetes enrolled in the UK Health Plan who participated in the DiabetesCARE program. INTERVENTION: Pharmacists provided medication therapy-related recommendations to health care providers. MAIN OUTCOME MEASURES: Acceptance of pharmacist recommendations by health care providers, length of time to acceptance, and cost savings attained with formulary recommendations. RESULTS: A total of 692 recommendations were sent to health care providers; 425 (61.4%) were accepted. A total of 578 clinical recommendations were related to drug therapy problems; 348 (60.2%) were accepted by health care providers. Median time to acceptance for clinical recommendations was 13.5 days (0-229). Formulary recommendations accounted for 114 (16%) of the total recommendations, 77 (67.5%) were accepted, and median time to acceptance was 47.2 days (0-172). Average monthly cost savings per accepted formulary recommendation was $13.59 for the health plan and $13.85 for the patient. CONCLUSION: A similar percentage of health care provider acceptance (61.4%) was seen compared with previous studies of pharmacists' interventions in different practice settings. To our knowledge, this is the first study to evaluate time to acceptance of pharmacist recommendations to health care providers, including the resolutions made through collaborative drug therapy management. Lastly, the current study reinforces the assertion that pharmacists can positively affect cost savings for both the patient and health plan, through formulary management.

Outcomes from DiabetesCARE: a pharmacist-provided diabetes management service.

OBJECTIVE: To describe outcomes attained by the DiabetesCARE component of the PharmacistCARE program, which is an innovative pharmacy practice model implemented within a self-insured employer. DESIGN: Descriptive nonexperimental study. SETTING: University of Kentucky (UK), from March 2003 through December 2006. PATIENTS: 236 patients with diabetes (95% with type 2 diabetes). INTERVENTION: Three clinical pharmacists provided UK Health Plan (UKHP) members with diabetes with comprehensive disease state and medication therapy management. MAIN OUTCOME MEASURES: Clinical outcomes included glycosylated hemoglobin (A1C), fasting lipid panels, blood pressure, weight, vaccination rates, and aspirin use. Humanistic outcomes included the mental and physical components of the 12-Item Short-Form Health Survey (SF-12) and patient satisfaction with health services related to their diabetes care. Screening parameters included the proportion of patients meeting Healthcare Effectiveness Data and Information Set expectations for patients with diabetes. Productivity and health resource use were also assessed based on patient responses to survey questions. RESULTS: After 1 year of enrollment, patients in the DiabetesCARE program achieved improved clinical outcomes compared with baseline, as evidenced by statistically significant reductions in A1C, low-density lipoprotein cholesterol, triglycerides, and total cholesterol. Statistically significant increases were seen in high-density lipoprotein cholesterol and the proportion of patients obtaining influenza vaccine, yearly screenings for lipid level assessment, screenings for kidney disease, and eye examinations. The mental component score of the SF-12 was significantly increased. Patients were highly satisfied with the DiabetesCARE service, and satisfaction with their overall diabetes care within UKHP was significantly enhanced. Based on the patient provided survey data analyzed here, productivity and health resource use were unchanged; however, additional analyses using UKHP claims data are ongoing. CONCLUSION: The DiabetesCARE program is a unique pharmacist-provided service delivered in a freestanding pharmacist clinic that enhances health outcomes for adult members with diabetes in a self-insured employer group.

PharmacistCARE: description of a pharmacist care service and lessons learned along the way.

OBJECTIVE: To describe the PharmacistCARE program, an innovative pharmacy practice model implemented within a self-insured employer and to describe lessons learned by the authors in implementing and maintaining the program. SETTING: University of Kentucky (UK), March 2003 to present. PRACTICE DESCRIPTION: A free-standing pharmacist clinic located within an ambulatory care facility owned by UK HealthCare. PRACTICE INNOVATION: PharmacistCARE, a pharmacist-provided patient care service for UK Health Plan members that includes comprehensive disease and medication therapy management. MAIN OUTCOME MEASURES: Various lessons learned by the authors during development, implementation, and maintenance of the program. RESULTS: The program has been recognized by the university as a positive contribution to health plan service enhancement and cost savings and has documented enhanced patient care outcomes. CONCLUSION: The PharmacistCARE program is a unique pharmacist-provided service delivered in a free-standing pharmacist clinic that enhances health outcomes for adult members in a self-insured employer group.

One hundred pound weight losses with an intensive behavioral program: changes in risk factors in 118 patients with long-term follow-up.

BACKGROUND: Treatment of severe obesity is difficult; in the past, lifestyle measures did not prove effective. Recently, however, intensive behavioral interventions using meal replacements and low-energy diets have enabled some severely obese persons to achieve nonobese weights. OBJECTIVE: We assessed rates of weight loss, changes in risk factors and medication requirements, and long-term weight maintenance in patients who lost >or=100 pounds (45.5 kg). DESIGN: Over a 9-y period, we prospectively identified patients who lost >or=100 pounds (45.5 kg) and actively recorded follow-up weights. Charts were systematically reviewed to assess outcome measures and side effects. The intervention included meal replacements (shakes and entrées), low-energy diets, weekly classes, and training in record keeping and physical activity. Assessments included weekly weights, laboratory studies, medication use, lifestyle behaviors, side effects, and follow-up weights. RESULTS: Sixty-three men and 55 women lost >or=100 pounds. At baseline, the subjects' average weight was 160 kg, 97% had >or=1 obesity-related comorbidity, and 74% were taking medications for comorbidities. Weight losses averaged 61 kg in 44 wk. Medications were discontinued in 66% of patients with a cost savings of $100/mo. Despite medication discontinuation, significant decreases in LDL cholesterol (20%), triacylglycerol (36%), glucose (17%), and systolic (13%) and diastolic (15%) blood pressure values were seen. Side effects were mild, and only 2 patients had severe or serious adverse events. At an average of 5 y of follow-up, patients were maintaining an average weight loss of 30 kg. CONCLUSION: Intensive behavioral intervention can be very effective with minimal risk for certain severely obese persons.

University and college of pharmacy collaboration to control health plan prescription drug costs.

OBJECTIVE: To describe the Raising Energy and Awareness in Campus Health (REACH) program, an innovative pharmacy practice model implemented within a self-insured employer. SETTING: University of Kentucky, Lexington. PRACTICE DESCRIPTION: A self-funded university-based health plan. PRACTICE INNOVATION/INTERVENTIONS: As part of a university-wide effort to control rising health care costs for 24,000 employees and dependents, four novel pharmacist services encompassed in the REACH program were provided: Co-Pay Counseling; Good Medicines; OutREACH; and Disease Management and Health Promotion. MAIN OUTCOME MEASURES: University health plan expenditures and health plan member out-of-pocket expenses for prescription medications. RESULTS: The REACH services were provided by 3.5 full-time equivalent pharmacists. Pharmacists evaluated health plan members' medications and conditions in an effort to identify more cost-effective treatment regimens in the Co-Pay Counseling program; provided confidential medication regimen review in the Good Medicines effort; provided informational programs at worksites within the university in the Out-REACH service; and worked with plan members and their health providers to prevent and/or minimize the impact of diseases such as diabetes and dyslipidemias. The overall university program and medication coinsurance strategy saved an estimated 1.6 million dollars in 2003-04. CONCLUSION: This unique package of employee benefits and services enabled the University of Kentucky to slow the growth of health care expenditures. Pharmacists were an important element in this effort.