Public Release: 

Rx for heart failure: patient-centered care from a pharmacist

Indiana University

INDIANAPOLIS - Heart failure patients have fewer emergency room visits and hospital stays and take their medicine more reliably when under the care of a pharmacist trained in patient-centered care, according to researchers from the University of North Carolina at Chapel Hill School of Pharmacy, the Indiana University School of Medicine, and the Regenstrief Institute, Inc. Their findings are published in the May 15 issue of the Annals of Internal Medicine.

In a study of 314 low-income Indiana residents with heart failure, patient-centered care by pharmacists working one-on-one with each patient to determine the best regime for taking prescribed medications, resulted in patients taking their medications 16 percent more consistently and 19% fewer emergency room visits and hospitalizations than patients who received typical services from their pharmacists.

"For every dollar spent on patients receiving care from specifically trained pharmacists, the health-care system gained $14 in savings by decreasing emergency room visits and hospitalizations," said Michael D. Murray, PharmD., M.P.H., Mescal S. Ferguson Distinguished Professor of the UNC School of Pharmacy and lead investigator of the study. Dr. Murray also is a Regenstrief Institute, Inc. affiliated scientist.

Study participants were divided into two groups. One group received typical services from pharmacists. The second group received care from a specifically trained pharmacist who had access to customized educational materials, provided comprehensive instruction to participants and reminded them to refill their prescriptions. The pharmacist worked to ensure that patients understood how their medications worked and why taking them consistently was important. The pharmacist also tailored the drug regime to each individual's lifestyle.

"Having pharmacists attuned to how patients take their medications and reinforcing their doctor's instructions is a win-win situation that reduced the use of expensive medical services. It is only through this kind of multidisciplinary approach to patient care that we will be able to improve patient benefits and increase safety of medication use," said D. Craig Brater, M.D., dean of the IU School of Medicine and a co-author of the study.

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The study investigators created specific written material designed to help patients with lower level of health literacy. For example, patients taking an ACE inhibitor received their pills in a bottle marked with an ace-of-hearts sticker. A corresponding information sheet, designed to be easy to read and understand, also was marked with the ace-of hearts. The educational materials used in the study can be viewed and downloaded at http://pharmacy.unc.edu/labs/cpop/document.2007-04-18.6005259157

The research was funded by the National Institutes of Health. In addition to Dr. Murray and Dr. Brater, co-authors of the study are James Young, PharmD., Wishard Health Services; Wanzhu Tu, Ph.D., Michael Weiner, M.D., and Daniel Clark, Ph.D., of the IU School of Medicine and the Regenstrief Institute; Jingwei Wu, M.S., and Irmina Gradus-Pizlo, M.D., of the IU School of Medicine; Faye Smith, MAS, of the Regenstrief Institute; Shawn Hoke of the Roudebush VA Medical Center; Daniel Morrow, Ph.D., of the University of Illinois; Kevin T, Stroupe, Ph.D., of the Hines VA Hospital, and Morris Weinberger, Ph.D., of the UNC School of Public Health.

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