Clinical and Economic Outcomes of Pharmacist Recommendations in a Veterans Affairs Medical Center

Audrey J. Lee, Maureen S. Boro, Katherine K. Knapp, Joy L. Meier, Nancy E. Korman


Am J Health Syst Pharm. 2002;59(21) 

In This Article

Abstract and Introduction

Pharmacist recommendations and their clinical and economic outcomes in a Veterans Affairs (VA) medical center were studied.

The first 600 pharmacist recommendations that met study criteria were evaluated for type and frequency, rate of acceptance by physicians, potential benefit or harm, and economic consequences. The study site included inpatient and outpatient settings and a skilled-nursing facility.

The most frequent types of pharmacist recommendations involved adjusting the dosage or frequency of administration and discontinuing a drug that was not indicated for the patient's medical problem. The rate of acceptance of the recommendations was 92%. The recommendations led to improved clinical outcomes in over 30% of cases in each setting and no change in over 40% of cases in each setting. Evaluators determined that patient harm was avoided by the recommendations in 90% of cases; patient harm was caused in less than 1% of cases. The overall mean cost avoidance per recommendation was $700, and the mean total cost avoidance for all 600 recommendations was $420,155.

Pharmacist recommendations improved clinical outcomes and saved money at a VA medical center.

New drugs and increasingly complex drug regimens increase health care costs and the likelihood of medication misuse. The importance of medication misuse was underscored in 1999 when the Institute of Medicine (IOM) recommended that the reduction of medical errors be considered a national priority.[1] In 2001, IOM emphasized the need to improve health care by adopting a team approach that crosses traditional boundaries of inpatient, outpatient, and nursing-home care.[2] An improved system approach has also been recommended for pharmacy practice.[3]

Pharmacists have an important role in decreasing medication misuse through collaborative drug therapy.[2,4] This role is not new for pharmacists.[4] Studies demonstrate that pharmacist recommendations can prevent medication errors and minimize adverse effects.[5,6,7] Other studies have shown that pharmacist recommendations can decrease the cost of therapy and improve outcomes.[8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29] However, many of these studies have been limited by the inability to capture information from a variety of practice settings or to capture both clinical and economic data.[8]

The Veterans Affairs (VA) health system is the nation's largest integrated health care system.[30] It is configured to deliver coordinated medication-use services across inpatient, outpatient, and skilled-nursing settings and facilitate pharmacist collaboration with physicians on drug therapy. Electronic information systems within the VA health system also facilitate collection of clinical and economic data.

The purpose of our study was to evaluate pharmacist recommendations in a VA medical center serving inpatients, outpatients, and nursing-home residents. The evaluation characterized the types and frequencies of recommendations and estimated the level of benefit or harm that would have occurred with and without them, as well as the economic and clinical consequences.


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