Marcia Frellick

December 08, 2014

Clinical pharmacists who perform medication reconciliation with new patients by telephone before their first visit to a primary care physician (PCP) can improve quality of care, researchers have found.

Pharmacists can help make sure that the patient is receiving optimal medication, Emily Barker, PharmD, a resident at Atrius Health, a nonprofit alliance operating in Massachusetts, told Medscape Medical News. They can prioritize medication concerns for the PCP so that important issues are addressed during appointments.

Results of the study were presented in a poster at the American Society of Health-System Pharmacists (ASHP) Midyear Clinical Meeting in Orange County, California.

In the 33-week prospective study, pharmacists called patients at least 50 years of age who were new to the Internal Medicine Department at Harvard Vanguard Medical Associates in Wellesley, Massachusetts. Patients who had joined the practice in the previous year served as the control group.

The pharmacist obtained an accurate medication list, checked for drug allergies, confirmed pharmacy preference, discussed medication issues, looked for cost-saving opportunities, and screened for adherence issues.

With this model, the pharmacist asks patients to check their medications when they are in their home environment. "They can just walk to their medicine cabinet and look at their pills and tell us exactly what they have," instead of trying to remember the list during their office visit, said Dr. Barker.

They can just walk to their medicine cabinet and look at their pills and tell us exactly what they have.

Recommendations were documented in the patient's electronic medical record and made available to the PCP before the visit. If a medication issue was identified, it was sent to the PCP electronically a day before the visit.

After the visit, the pharmacist would review the electronic medical record to determine whether the recommendation was acted on. For the control group, the pharmacist performed a medication reconciliation remotely and documented medication issues in a database concealed from the PCP. The pharmacist then compared the concealed recommendations with the recommendations addressed by the PCP.

The researchers found that more recommendations were addressed in the study group than in the control group (42% vs 15%; P =.001).

An anonymous unvalidated questionnaire was distributed to all participating PCPs. The intervention was found to be beneficial by 77% of respondents and, on average, the service saved PCPs 5 minutes per visit.

Return on investment was calculated to be 7.3:1.0, meaning that for every $7.30 of healthcare savings, $1.00 went toward the cost of having the pharmacist perform the medication reconciliation. Cost savings came when a recommendation to switch to a lower-cost option was followed.

It is good to see the model working in smaller health systems, said Marilyn Stebbins, PharmD, from the School of Pharmacy at the University of California, San Francisco.

"Kaiser Permanente has been using this model in their integrated healthcare system, and they have shown it to be effective," she reported. "It's really important to test these models," she said, "and it looks like they are replicable."

Dr. Stebbins added that, in this scenario, pharmacists can work at the top of their license and free up physicians to make decisions only physicians can make, making care more efficient. This is particularly important when newly insured patients with complex concerns are making their first visit to a PCP.

Pharmacists can also help with continuity of care, Dr. Stebbins said. If they find that the patient is close to running out of a medication, they can arrange to get refills to the patient, eliminating nonadherence problems before the PCP visit.

Dr. Barker and Dr. Stebbins have disclosed no relevant financial relationships.

American Society of Health-System Pharmacists (ASHP) Midyear Clinical Meeting: Poster 4-016.


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