Pharmacists Making a Difference

...On Healthcare Costs

Prescription medications are the second most costly component of health care, accounting for almost 14% ($29 billion) of Canada’s annual health care spending in 2013.1 Pharmacists are uniquely positioned in the healthcare system to optimize drug therapy and save money through the delivery of clinical pharmacy services. For example, through a hypertension management program, pharmacists were able to create annual cost savings estimated at $265/patient for a one year program.2  Additionally, a savings of $286/month were achieved for patients who reduced their cigarette use through a pharmacist-led smoking cessation service.3

Can pharmacists really make a difference?

Numerous studies have shown that a pharmacist can help achieve maximum health outcomes for the lowest possible cost to the system.4 When pharmacists were actively involved in direct patient care and drug use programs, the following results were reported:

  • better patient outcomes or underlying health5-7
  • decreased emergency room visits8,9
  • decreased hospital admissions8,10
  • decreased institutional length of stay6,11
  • decreased healthcare costs8
  • fewer adverse drug reactions5,6,8

How do pharmacists help in cost-containment and drug-use management?

The pharmacist:

  • decreases overall health care costs by focusing on optimal medication use, avoidance or minimization of problems related to drug therapies, and achievement of desired patient outcomes 
  • provides specialized services to specific patient groups (asthma, hypertension) to optimize medication use and outcomes. In turn, this process helps in decreasing office, hospital and emergency room visits
  • provides education to physicians on appropriate prescribing for specific diseases to ensure appropriate utilization of high cost drugs
  • participates in antimicrobial stewardship teams to reduce the inappropriate use of antibiotics
  • implements programs to enhance adherence to specific prescribing guidelines to optimize medication use
  • develops and implements programs to promote use of outpatient therapy and monitoring thus resulting in decreased institutional admissions and/or length of stay

Research has shown that pharmacist interventions are reflected in both direct and indirect cost-savings. The greater the availability of the pharmacist, the greater the return in investment.

References

  1. Canadian Institute for Health Information. National Health Expenditures Trends, 1975 to 2013. Available at: https://secure.cihi.ca/ free_products/NHEXTrendsReport_EN.pdf
  2. Bugden, S., K. Hamilton, B. Shearer, K. Friesen, and S. Alessi-Severini. Manitoba Pharmacist Initiated Smoking Cessation Pilot Project. 2015. www.msp.mb.ca/files/Smoking%20Cessation_Report%20in%20Brief_Final.pdf (accessed June 10, 2016).
  3. Houle SK, Chuck AW, McAlister FA, Tsuyuki RT. Effect of a pharmacist-managed hypertension program on health system costs: an evaluation of the Study of Cardiovascular Risk Intervention by Pharmacists—Hypertension (SCRIP–HTN) Pharmacotherapy. 2012; 32(6):527–537. doi: 10.1002/j.1875-9114.2012.01097.x. [PubMed]
  4. Kehrer J, Eberhart G, Wing M et al. Pharmacy’s role in a modern health continuum. CPJ. 2013; 146 (6): 321-324
  5. Chisolm-Burns MA. Kim LJ, Spivey CA. US pharmacists’ effect as team members on patient care: systematic review and meta-analyses. Med Care. 2010;48:923-933
  6. Kaboli PJ, Hoth AB, McClimon BJ, Schnipper JL. Clinical pharmacists and inpatient medical care: A systematic review. Arch Intern Med. 2006 [cited 2017 Mar 19];166(9):955-64. Available from: http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/410298
  7. Santschi V, Chiolero A, Burnand B, Colosimo AL, Paradis G. Impact of pharmacist care in the management of cardiovascular disease risk factors: a systematic review and meta-analysis of randomized trials. Arch Intern Med. 2011;171(16):1441-5
  8. Gillespie U, Alassaad A, Henrohn D, Garmo H, Hammarlund-Udenaes M, Toss H, et al. A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older: a randomized controlled trial. Arch Intern Med. 2009;169(9):894-900.
  9. Christensen M, Lundh A. Medication review in hospitalised patients to reduce morbidity and mortality. Cochrane Database of Systematic Reviews 2016, Issue 2. Art. No.: CD008986. DOI: 10.1002/14651858.CD008986.pub3
  10. Makowsky MJ, Koshman SL, Midodzi WK, Tsuyuki RT. Capturing outcomes of clinical activities performed by a rounding pharmacist practicing in a team environment: The collaborate study. Med Care. 2009;47(6):642-50.
  11. Bond CA, Raehl CL, Franke T. Interrelationships among mortality rates, drug costs, total cost of care, and length of stay in United States hospitals: summary and recommendations for clinical pharmacy services and staffing. Pharmacotherapy. 2001;21:129-141.

...On Patient Care/Health Outcomes

Misuse of drugs is a major health concern. Studies have shown that 50% of Canadians do not take their prescription medications exactly as prescribed 1. Medication non-adherence has been reported to be the cause of 30% to 50% of treatment failures and 125,000 deaths annually 3. Adverse drug reactions (ADRs) have been estimated to account for up to two-thirds of drug-related hospital admissions and ED visits 4-7. Medications are an important tool in the management of health, but if they are not used properly, they can cause serious harm. Pharmacists, the drug experts, have an important role in preventing medication adverse events and reducing hospital admissions.

Can pharmacists really make a difference?

Many papers have shown that a pharmacist can make a significant difference in patient care 8, 9. When pharmacists are directly involved in patient care:

  • the patient's knowledge of their disease is improved
  • the patient's knowledge and understanding of their drug therapy is improved
  • adherence with medication therapies is improved
  • drug related problems are more readily identified and resolved, reducing patient risk
  • the patient's overall management of their disease is improved, resulting in lower incidence of hospital admissions, and shorter lengths of stay
  • the patient's quality of life and overall satisfaction with their drug therapy is improved

How do pharmacists help patients?

The pharmacist:

  • works with the patient to achieve desired outcomes related to drug therapy
  • educates patients on optimal medication use, device technique and self-monitoring
  • conducts medication reviews and patient assessments to identify and solve drug therapy problems
  • works with the patient to adjust drug therapy based on beliefs, values and preferences
  • provides information on how to comply with drug therapies to facilitate the appropriate use of medication
  • performs follow-up activities to address any concerns patients may have with respect to their drug therapy
  • provides additional education tools (videos, information sheets, websites) to help patients understand specific medications and diseases
  • provides specialized services for specific patient groups (i.e., high blood pressure, asthma, diabetes)
  • collaborates with other members of the healthcare team to facilitate medication management
  • may extend prescriptions and make therapeutic substitutions to optimize drug therapy
  • may provide injection and vaccination services

By performing the above functions, the pharmacist works with the patient to achieve desired outcomes related to drug therapy. In addition, by providing more comprehensive patient care, the pharmacist works with the patient to minimize or avoid outcomes related to: adverse effects, doses that are not therapeutic (too high or too low) and/or drug interactions.

What role does the pharmacist play in the healthcare team?

The pharmacist:

  • works as an independent healthcare professional accessible to patients and other care providers
  • provides information pertaining to medication use to assist in decisions related to drug therapy
  • notifies physicians about contraindications, drug interactions and/or intolerances to drug therapy
  • notifies other members of the healthcare team of potential risks associated with drug therapies
  • assists with monitoring drug therapy and medication use to facilitate the achievement of patient specific goals
  • serves as a resource for up-to-date evidence based drug information
  • assists in decisions related to drug therapy after evaluating patient-specific factors from medication and medical history
  • implements programs to enhance communication between community and hospital settings, resulting in better patient-care through collaborative treatment schemes and follow-up monitoring

By performing the above functions, a pharmacist positively impacts a physician's practice as well as that of the other members of the healthcare team through the provision of valuable patient-specific information related to drug therapy. This information facilitates the decision-making process which will ultimately influence patient-specific outcomes. In addition, active participation of a pharmacist complements the care by ensuring patients are working toward desired goals and avoiding problems related to drug therapies.

Bibliography

  1. Sabaté E, editor. , ed. Adherence to Long-Term Therapies: Evidence for Action. Geneva, Switzerland: World Health Organization; 2003.
  2. Lee JK, Grace KA, Taylor AJ. Effect of a pharmacy care program on medication adherence and persistence, blood pressure, and low-density lipoprotein cholesterol: a randomized controlled trial. JAMA. 2006;296(21):2563-2571 [PubMed]
  3. Ho 2009, Circulation; Edmondson 2013, Br J of Health Psychology; George & Shalansky 2006, Br J Clin Phar
  4. Patel H, et al. Trends in Hospital Admissions for Adverse Drug Reactions in England: Analysis of National Hospital Episode Statistics 1998-2005, BMC Clinical Pharmacology. 2007; 7:9.
  5. Lazarou J, Pomeranz BH, Corey PN. Incidence of Adverse Drug Reactions in Hospitalized Patients: A Meta-Analysis of Prospective Studies. JAMA. 1998; 279(15):1200-1205.
  6. Zed P, et al. Incidence, Severity and Preventability of Medication-Related Visits to the Emergency Department: A Prospective Study. Canadian Medical Association Journal. June 3, 2008; 178(12): 1563-1569.
  7. Wu C. Adverse Drug Reactions in the Emergency Department Population in Ontario: Analysis of National Ambulatory Care Reporting System and Discharge Abstract Database 2003-2007. University of Toronto. 2009.