Innovative Pharmacy Services Jann B. Skelton, RPh, MBA Vice President of Operations MEDICA

The BIG Picture….

Project ImPACT: Hyperlipidemia n National demonstration project of the APhA Foundation n Deployed in 29 Pharmacies across 14 states n Over 600 patients enrolled Sponsored through an unrestricted grant from Merck and Co.

Project ImPACT: Hyperlipidemia Rationale n Hyperlipidemia is a modifiable risk factor in coronary heart disease n Pharmacists services are widely accessible n Evidence suggest that pharmacists can improve both compliance and outcomes n A point-of-care testing device, the Cholestech LDX Analyzer is available to pharmacists with patient results available in 5 minutes n The management of cholesterol disorders represents a major benchmark by which health care quality can be evaluated

Current Detection and Treatment n The majority of patients with lipid disorders are often not identified and not treated. n On average, only... –35% of patients are diagnosed –32% of patients are prescribed a diet –12% of qualifying patients are prescribed a drug Adapted from Am J Cardiol 1998; 82:61-5

Financial Burden of CAD estimated in billions of dollars

Simons, et al MJA 1996; 164:208 n = 610 Patients Discontinuing Therapy

Adherence Comparison Adherence Comparison Existing Delivery System Project ImPACT Model MJA 1996; 164:208, JAPhA 1998; 38:

Medication Waste Costs for 1000 Patients in a Health Plan due to Noncompliance n MonthPts Discontinuing TxCost 1200 x 1x $63$12, x 2 x $63$ 6, x 3 x $63$ x 4 x $63$12, x 5 x $63$15, x 6 x $63$37, x 7 x $63$22,050 TOTAL COSTS$135,450

Examples of Innovative Pharmacy Services n Osteoporosis n Cardiovascular Disease n Skin Damage n Weight Management n Glaucoma n Diabetes

Examples of Innovative Pharmacy Services n Immunizations n Asthma n Smoking Cessation n Hypertension n Alzheimer’s n Depression n Urinary Incontinence

How many have had these types of services provided by their pharmacist?

The Pharmacist’s Role in Disease Prevention and Management n Perform patient risk assessment and health screening –Identify patients at risk –Support compliance and adherence to prescribed medication and behavioral therapies n Deliver patient education on disease prevention and disease management strategies

The Pharmacist’s Role in Disease Prevention and Management n Refer to physician for follow-up –Physician provides diagnosis and prescribes therapy n Pharmacist monitors drug therapy –Provides ensures compliance and adherence –Immediate interventions when problems are identified

Identifying Individuals at Risk n 80% of the population with osteoporosis is undiagnosed n 50% of the 2 million Americans with glaucoma are unaware that they have the disease n 33% of diabetics are unaware of their condition n 65% of patients with high cholesterol are unaware until their first cardiac event

The Importance of Professional Collaboration n Less than 1% of physicians in the US are involved in preventive care programs –Time constraints –Financial incentives n Pharmacists become a referral source for physicians n Improved cooperation and information flow improves patient care