Pharmacists trained in pharmaceutical care, the practice of identifying, resolving, and preventing drug therapy problems that adversely affect patients' care, can safely solve patient medication problems, including potentially dangerous drug interactions, by using the collaborative care approach, according to the study published today in the Archives of Internal Medicine. A pharmacist-physician partnership is one type of collaborative care, which is increasingly offered in health care settings.
The study, which examined the collaborative care approach of pharmaceutical care, was conducted by researchers from the University of Minnesota College of Pharmacy and Fairview Health Services. The study, which judges the quality of care delivered by pharmacists, is the first to use the same quality-assurance process physicians employ.
"Not only did patients, pharmacists, physicians and other health care providers work together to identify and resolve an average of 2.3 drug therapy problems per patient, but physicians agreed with more than 94 percent of all clinical decisions made by pharmacists to help patients achieve their treatment goals and resolve drug therapy problems," says Brian Isetts, Ph.D., B.C.P.S., lead researcher on the study.
The percentage of patients who had the desired effect from their drug therapy increased from 74 percent during their initial visits to the pharmaceutical care clinic to 89 percent at their latest visit. The study also found pharmacists were able to resolve the drug-therapy problems without directly involving the patients' physicians in many cases. For example, pharmacists increased compliance by making complicated drug regimens more understandable and more manageable for the patient.
A 12-member panel of physicians and pharmacists reviewed randomly selected patient records from the pharmaceutical care clinics. Panelists agreed with the pharmaceutical care providers' evaluations in 94.2 percent of the cases and disagreed in only 2.2 percent of the cases."The decisions made by pharmaceutical care practitioners working in collaboration with physicians to provide drug therapy management services are clinically credible," the researchers wrote.
There were 5,897 drug therapy problems that were resolved among the 2,524 patients in Fairview's Pharmaceutical Care Program. The most common problems pharmaceutical care providers found were the need for additional therapy, adjustment of incorrect doses, patient compliance with medication orders, adverse drug reactions, and ineffective drug therapy.
Each of the 2,524 patients had an average of 6.5 medical conditions and took an average of 8.2 medications. The most frequent drug therapy problems were in treatments for osteoporosis, asthma, nutritional supplements, hypertension, and hypothyroidism.
Previous studies show that pharmacists working with physicians can prevent errors and reduce drug costs. In 1995 the cost of drug therapy problems in the U.S. health care system was around $76 billion. By 2000, that cost had increased to $177 billion.
The pharmaceutical care clinics, a collaboration between pharmacists and physicians, exist at six Fairview clinics in the Minneapolis and St. Paul area. The program began in 1999, and all patients treated at the six clinics can receive pharmaceutical care services regardless of their ability to pay or their health insurance status.
Pharmacists complete a 120-hour, eight-week, 50-patient certificate preparation program in pharmaceutical care provided by the Peters Institute of Pharmaceutical Care at the University of Minnesota College of Pharmacy. The program focuses on a philosophy of practice and process of care and prepares pharmaceutical care practitioners to identify, resolve and prevent drug therapy problems.
Journal
Archives of Internal Medicine