Devices for ambulatory and home monitoring of blood pressure, lipids, coagulation, and weight management, part 1

Reimbursement model for pharmacist-directed medication therapy management

OBJECTIVE

To describe the development of a practice model with sustainable reimbursement for medication therapy management (MTM) services provided by pharmacists for beneficiaries of self-insured health care plans.

PRACTICE DESCRIPTION

The Auburn University Pharmaceutical Care Center (AUPCC) is a free-standing clinic located within the school of pharmacy that provides preventive care and MTM services for a population of 11,600 employees and dependents that subscribe to the university's self-insured health plan. The goal of patient care is to increase use of cost-effective pharmacotherapy and improve the outcomes of medication use among the population.

MAIN OUTCOME MEASURES

Development and implementation of a practice model and reimbursement method that can be implemented in the employer setting for large self-insured employers and the community pharmacy practice setting.

RESULTS

Since opening, AUPCC has developed into a model pharmaceutical care service that can be implemented in the workplace for other self-insured employers. AUPCC is also a model that can easily translate to the community pharmacy setting. In 2010, the model was adapted by Alabama for state employees.

CONCLUSION

Pharmacists can negotiate directly with decision makers within large companies that are self-insured to provide MTM services for the employee population. This is an area of sustainable growth within our profession.

Impact of a Pharmaceutical Care Intervention on Blood Pressure Control in a Chain Pharmacy Practice

BACKGROUND

Hypertension affects over 50 million Americans, with only 50% of patients being adequately controlled. Several pharmacist counseling and pharmacist-physician comanagement studies have documented that community pharmacist interventions improve blood pressure (BP) management.

OBJECTIVE

To determine whether community pharmacists can improve clinical endpoints including hypertension control, drug therapy dosing, adherence to prescribed regimens, adverse drug reaction incidence, patient understanding, response to therapy, and quality-of-life.

METHODS

The program included the education and training of a group of 18 chain community pharmacists in hypertension therapies, monitoring, and management. Protocols and documentation tools were based on nationally accepted clinical practice guidelines for hypertension in place at the time of the study. Pharmaceutical care (PC) was then compared with usual care (UC) over a 12-month period.

RESULTS

The study initially enrolled 180 PC and 196 UC patients, with 44% (PC) and 32% (UC) of the patients reporting a final BP measurement. A larger proportion (50%) of PC patients who had poorly controlled hypertension at baseline (>140/90 mm Hg) were controlled compared with UC patients (22%). The average reduction in systolic BP was 9.9 mm Hg in PC patients compared with 2.8 mm Hg in UC patients (p < 0.05). Changes in diastolic BP were similar in the PC and UC groups. Based on patient self-report, PC patients were more likely to say that they take their medicines as prescribed compared with UC patients (p < 0.05). The 1- to 6-month antihypertensive adherence rate was higher in PC patients (0.91 ± 0.15) compared to UC patients (0.78 ± 0.30) (p = 0.02); there was no significant difference in adherence rate during the 7- to 12-month period.

CONCLUSIONS

Community pharmacists can positively affect patient medication adherence during the 6-month period following counseling by a pharmacist along with an improvement in patient BP. However, there is much room for improvement in PC programs and in the number of patients who properly adhere to their medications.