1. Pharmacist Interventions and Healthcare Utilization and Cost
Amanda Lewis, Natasha Gregory, Ernest McDonald, Juan Sotolongo, Grashma Vadakkel, Lalita Rayaprolu

2. Objective Need for pharmacist interventions
Reduce healthcare utilization and cost
Provide evidence based information
Provide what types of pharmacist interventions increase medication adherence, and reduce healthcare utilization, and by how much

3. The Importance of Pharmacist Interventions
“...enhanced role of advocating for proper use of medications to avoid medication errors and achieve desired outcomes.”
Decreasing health care cost and utilization
Medication adherence
Patient education
Effective communication & establishing patient relationships
Medication therapy management
Being a member of a healthcare team

4. Reducing Healthcare Utilization: Physician
Drug therapy consultant
Patient/doctor drug therapy liaison
Reduce drug related litigation events
Well visits
Community setting
Follow-ups

5. Reducing Healthcare Utilization: Hospitalizations & ED Visits
Medication errors occurred in 5.22% of patients admitted to hospitals.
In 2008 it was estimated that hospital medication errors cost over $17.1 billion.
How can pharmacists help reduce these numbers? - -
-In 2009 it was estimated that hospital medication errors cost over 1 billion dollars.
-Ideally, the pharmacist should collaborate with the prescriber in developing, implementing, and monitoring a therapeutic plan to produce defined therapeutic outcomes for the patient.
-It is also vital that the pharmacist devote careful attention to dispensing processes to ensure that errors are not introduced at that point in the medication process….ASHP Guidelines on Preventing Medication Errors in Hospitals
-A total of 429,827 medication errors were evaluated from 1081 hospitals (study population). Medication errors occurred in 5.22% of patients admitted to these hospitals each year. Hospitals experienced a medication error every hours (every admissions). These findings suggest that at minimum, 90,895 patients annually were harmed by medication errors in our nation's general medical-surgical hospitals.
-Factors associated with increased medication errors/occupied bed/year were drug-use evaluation (slope = , p=0.006), increased staffing of hospital pharmacy administrators/occupied bed (slope = , p<0.001), and increased staffing of dispensing pharmacists/occupied bed (slope = , p<0.001). Factors associated with decreased medication errors/occupied bed/year were presence of a drug information service (slope = − , p<0.001), pharmacist-provided adverse drug reaction management (slope = − , p<0.001), pharmacist-provided drug protocol management (slope = − , p=0.013), pharmacist participation on medical rounds (slope = − , p<0.001), pharmacist-provided admission histories (slope = − , p<0.001), and increased staffing of clinical pharmacists/occupied bed (slope = − , p<0.001). As staffing increased for clinical pharmacists/occupied bed from the 10th percentile to the 90th percentile, medication errors decreased from ± to ± /hospital/year, a decrease of 286%.

6. Reducing Healthcare Utilization: Cost
One year evaluation of 5 healthcare teams
3 teams included pharmacist
Average cost saving for team that include pharmacist- 377$ per inpatient admission
Increase in medication adherence
Lower on average LOS
Benefit-to-Cost Ratio 6.03:1
Pharmacist provide population-based pharmaceutical care
Switches to generic medications and switches from RX to OTC
Disease management programs
Negotiations with health plans and P/A
Implemented EHR
Patients with controlled BP increased from 45-60%
Saved 450,000$ in inpatient cost for DVT
That article was from1993

7. Evidence-base Interventions: Reduce patient mortality
The role of the clinical pharmacist in reducing mortality in hospitalized cardiac patients: A prospective, nonrandomized controlled trial using propensity score methods
Results
Pharmacist intervention caused all cause mortality to fall from 1.8% and 1.1%. There was no statistical difference in the control group.
Conclusion
Pharmacist identified drug related problems, and physician’s correction of a drug-related problem after pharmacist advice caused a significant decrease in all-cause mortality in cardiac patients.

8. Evidence-based Interventions: Hospital Length of Stay
Clinical pharmacists and inpatient medical care
Results:
Of the 36 studies reviewed, there was a shortened length of stay in 9 of the studies.
Reductions seen in adverse drug events and medication errors
Improvements seen in medication adherence and knowledge
Conclusion:
Implementing a clinical pharmacist in an inpatient setting greatly improved care without any harm
This was a systematic review that looked at 36 studies and they were categorized based on the clinical pharmacy services: patient care unit where pharmacists were on rounds, admission/discharge, med recon, and drug-class specific services
Looking specifically at the results for the admission/discharge and med recon. When the medication history was taken by a pharmacist opposed to a nurse there was more accurate medication and allergy information. Pharmacists were faster and could catch any interactions or errors.
Pharmacy discharge counseling showed that patients were more adhering to their medications and were aware of what they were taking.

9. Summary
Reduce healthcare utilization by corresponding with physicians and providing different services (ex: drug therapy consultations)
Decrease the amount of medication errors, ultimately decreasing hospital admissions and lengths of stay, and patient mortality
Incorporating pharmacists as part of a patient’s healthcare team, can reduce cost
In terms of the future:
Studies with a larger sample size, reproducible interventions and identifying patient-specific factors that led to improved outcomes

10. References
Kelly W, Peterson A. Leadership and Management if Pharmacy Practice. CRC Press, 2015.
American Society of Hospital Pharmacists. ASHP guidelines on preventing medication errors in hospitals. Am J Hosp Pharm. 1993; 50:305–14.
Bond, C. A., Raehl, C. L. and Franke, T. (2002), Clinical Pharmacy Services, Hospital Pharmacy Staffing, and Medication Errors in United States Hospitals. Pharmacotherapy, 22: 134–147. doi: /phco
Bjornson DC, Hiner WO, Potyk RP, et al. Effect of pharmacists on health care outcomes in hospitalized patients. Am J Hosp Pharm. 1993;50(9):
Devine EB, Hoang S, Fisk AW, Wilson-norton JL, Lawless NM, Louie C. Strategies to optimize medication use in the physician group practice: the role of the clinical pharmacist. J Am Pharm Assoc (2003). 2009;49(2):
Zhai XB, Tian DD, Liu XY. The role of the clinical pharmacist in reducing mortality in hospitalized cardiac patients: A prospectve, nonrandomized controlled trial using propensity score methods. Int J Clin Pharamcol Ther. 2015; 53(3):
Kaboli PJ, Hoth AB, McClimon BJ, Schnipper JL. Clinical pharmacists and inpatient care. JAMA Intern Med May:166:

11. What questions do you have?
Thank You
What questions do you have?