Kathleen A. Johnson

Pharmacist-provided medication therapy management (part 2): Payer perspectives in 2007

OBJECTIVES To collect and describe payer perspectives regarding (1) implementation strategies used for providing medication therapy management (MTM) services to patients/clients; (2) specific measures, if any, used to quantify the costs and benefits of MTM; (3) how the value of MTM services was tracked during 2007; and (4) barriers to offering MTM services to patients/clients. DESIGN Descriptive, nonexperimental, cross-sectional study. SETTING United States during 2007. PARTICIPANTS Of the 1,898 payers who presumably received an e-mail invitation to participate in the survey, 132 (7%) responded. In addition to the online survey, 20 individuals who reported that they developed or used MTM for their organization participated in a telephone interview consisting of open-ended questions. INTERVENTIONS Self-administered online survey and telephone interview. MAIN OUTCOME MEASURES Implementation and monitoring of MTM. RESULTS The results showed that 20% (n = 26) of the e-mail survey respondents offered MTM services to their members as described in the consensus definition of MTM. Payers for MTM services varied widely on how they implemented and monitored their organizations MTM programs. For 2008, MTM payer organizations plan to expand their use of face-to-face pharmacist-patient interaction. CONCLUSION During 2008, plans may have greater opportunity to measure outcomes in a longitudinal fashion and make adjustments to MTM provision strategies. Some evidence for this was suggested in respondent comments to our survey, but future validation is needed before reaching a firm conclusion.

The Impact of Clinical Pharmacy Services Integrated into Medical Homes on Diabetes-Related Clinical Outcomes

Background: Pharmacist services have expanded in the US health-care system from traditional roles to include comprehensive clinical services, but many studies lack comparison groups to evaluate outcomes of these clinical services. Objective: To evaluate the clinical outcomes of uninsured or underinsured patients with type 2 diabetes who received care from pharmacists in local “safety net” clinic medical homes compared to outcomes of patients from clinics receiving usual care without the services of clinical pharmacists. Methods: Pharmacists provided comprehensive pharmacy services in safety net clinic medical homes for uninsured patients in a major urban city. Referred patients had poor diabetes control (hemoglobin A1c [A1C] >9%). Pharmacists conducted comprehensive evaluations of medications, made adjustments, monitored adherence, and provided education and follow-up. Intervention patients were compared to similar patients who were receiving usual care but were not seen by a pharmacist. Outcomes evaluated were the change in A1C levels and achievement of treatment goals. Data were derived from chart reviews retrospectively. Multivariate least-squares and logistic regression models were used to estimate the impact of the intervention. Results: Two hundred twenty-two intervention and 262 control patients were evaluated. Patients receiving care from pharmacists had adjusted A1C levels reduced by 1.38% relative to usual care, increasing the likelihood of achieving an A1C <7% by 3-fold (p < 0.001 for both estimates). Conclusions: The integration of clinical pharmacy services into safety net medical homes was associated with improvement in clinical outcomes of patients with diabetes.

Quality of life in haemophilia A: Hemophilia Utilization Group Study Va (HUGS‐Va)

Summary.  This study describes health‐related quality of life (HRQoL) of persons with haemophilia A in the United States (US) and determines associations between self‐reported joint pain, motion limitation and clinically evaluated joint range of motion (ROM), and between HRQoL and ROM. As part of a 2‐year cohort study, we collected baseline HRQoL using the SF‐12 (adults) and PedsQL (children), along with self‐ratings of joint pain and motion limitation, in persons with factor VIII deficiency recruited from six Haemophilia Treatment Centres (HTCs) in geographically diverse regions of the US. Clinically measured joint ROM measurements were collected from medical charts of a subset of participants. Adults (N = 156, mean age: 33.5 ± 12.6 years) had mean physical and mental component scores of 43.4 ± 10.7 and 50.9 ± 10.1, respectively. Children (N = 164, mean age: 9.7 ± 4.5 years) had mean total PedsQL, physical functioning, and psychosocial health scores of 85.9 ± 13.8, 89.5 ± 15.2, and 84.1 ± 15.3, respectively. Persons with more severe haemophilia and higher self‐reported joint pain and motion limitation had poorer scores, particularly in the physical aspects of HRQoL. In adults, significant correlations (P < 0.01) were found between ROM measures and both self‐reported measures. Except among those with severe disease, children and adults with haemophilia have HRQoL scores comparable with those of the healthy US population. The physical aspects of HRQoL in both adults and children with haemophilia A in the US decrease with increasing severity of illness. However, scores for mental aspects of HRQoL do not differ between severity groups. These findings are comparable with those from studies in European and Canadian haemophilia populations.

The Effects of Consultation on Over-the-Counter Medication Purchasing Decisions

This article examines factors that predict changes in consumer purchasing decisions of nonprescription medications. Variables corresponding to factors in Andersens behavioral model are measured, in addition to data regarding characteristics of the 17 pharmacy consultants who provided counseling services. One thousand seven hundred and thirteen consumers in five stores in southern California were provided consultation during a 6-month period, resulting in 25.4% of the patients purchasing a different drug than intended when entering the pharmacy, 1.3% being referred to a physician, and 13.4% not purchasing any over-the-counter medication at all. Logistic regression techniques demonstrated that one enabling variable (availability of generic medications), and four need factors (the discussion of clinical issues, short encounters, cough and cold products, and vitamin products) were significant predictors of the consumers decision to purchase a different product than intended. Consultant characteristics (introversion, external locus of control) were also important predictors, but opposite the expected direction. Consumers who received information from female consultants were more likely to change their purchasing decisions.

Burden of illness: direct and indirect costs among persons with hemophilia A in the United States.

Abstract Objective: To examine the direct and indirect costs of hemophilia care among persons with hemophilia A in the US. Methods: Observational data were obtained from HUGS-Va, a multi-center study from six federally supported hemophilia treatment centers (HTCs). Eligible individuals completed a standardized initial questionnaire and were followed regularly for 2 years to obtain information on work or school absenteeism, time spent arranging hemophilia care, and unpaid hemophilia-related support from caregivers. Data from 1-year healthcare utilization records and 2-year clotting factor dispensing records measured direct medical costs. Indirect costs were imputed using the human capital approach, which uses wages as a proxy measure of work time output. Results: A total of 222 patients with complete data were included in the analysis. Two-thirds had severe hemophilia and the mean age was 21.1 years. The use of prophylaxis in severe hemophilia patients is associated with statistically significant reduction in the numbers of emergency department (ED) visits and bleeding episodes compared with those who were treated episodically. From the societal perspective, mild hemophilia costs

Haemophilia Utilization Group Study - Part Va (HUGS Va): design, methods and baseline data

59,101 (median:

Comparative effectiveness of statin plus fibrate combination therapy and statin monotherapy in patients with type 2 diabetes: use of propensity-score and instrumental variable methods to adjust for treatment-selection bias

7519) annually per person,

Measuring the impact of patient counseling in the outpatient pharmacy setting : the research design of the Kaiser permanente/USC patient consultation study

84,363 (median:

Measuring the impact of patient counseling in the outpatient pharmacy setting: development and implementation of the counseling models for the kaiser permanente/USC patient consultation study

61,837) for moderate hemophilia,

pharmacists in public health: it's a good start!

201,471 (median: