innovative pharmacy services jann b. skelton, rph, mba vice president of operations medica
TRANSCRIPT
Innovative Pharmacy ServicesInnovative Pharmacy Services
Jann B. Skelton, RPh, MBAJann B. Skelton, RPh, MBA
Vice President of OperationsVice President of Operations
MEDICAMEDICA
The BIG Picture….The BIG Picture….
Project ImPACT: HyperlipidemiaProject ImPACT: Hyperlipidemia
National demonstration project of the APhA National demonstration project of the APhA FoundationFoundation
Deployed in 29 Pharmacies across 14 statesDeployed in 29 Pharmacies across 14 states Over 600 patients enrolledOver 600 patients enrolled
Sponsored through an unrestricted grant from Merck and Co.Sponsored through an unrestricted grant from Merck and Co.
Hyperlipidemia
Project ImPACT: HyperlipidemiaProject ImPACT: HyperlipidemiaRationaleRationale
Hyperlipidemia is a modifiable risk factor in coronary Hyperlipidemia is a modifiable risk factor in coronary heart diseaseheart disease
Pharmacists services are widely accessiblePharmacists services are widely accessible Evidence suggest that pharmacists can improve both Evidence suggest that pharmacists can improve both
compliance and outcomescompliance and outcomes A point-of-care testing device, the Cholestech LDX A point-of-care testing device, the Cholestech LDX
Analyzer is available to pharmacists with patient results Analyzer is available to pharmacists with patient results available in 5 minutesavailable in 5 minutes
The management of cholesterol disorders represents a The management of cholesterol disorders represents a major benchmark by which health care quality can be major benchmark by which health care quality can be evaluatedevaluated
Current Detection and TreatmentCurrent Detection and Treatment
The majority of patients with lipid disorders The majority of patients with lipid disorders are often not identified and not treated.are often not identified and not treated.
On average, only...On average, only...– 35% of patients are diagnosed35% of patients are diagnosed– 32% of patients are prescribed a diet32% of patients are prescribed a diet– 12% of qualifying patients are prescribed a 12% of qualifying patients are prescribed a
drugdrug
Adapted from Am J Cardiol 1998; 82:61-5
Financial Burden of CADFinancial Burden of CADestimated in billions of dollarsestimated in billions of dollars
0 10 20 30 40 50
Home Health
Medications
Physicians
Hospitalizations
Simons, et al MJA 1996; 164:208
n = 610
Patients Discontinuing TherapyPatients Discontinuing Therapy
0
10
20
30
40
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10 11
Months on lipid lowering therapy
% o
f p
atie
nts
on
th
erap
y
Adherence ComparisonAdherence Comparison
0 1 2 3 4 5 6 7 8 9 10 11
0
20
40
60
80
100
% o
f p
ati
en
ts o
n t
he
rap
y
Months on lipid lowering therapy
Existing Delivery System
Project ImPACT Model
Hyperlipidemia
MJA 1996; 164:208, JAPhA 1998; 38:529-34.
Medication Waste Costs for 1000 Medication Waste Costs for 1000 Patients in a Health Plan due to Patients in a Health Plan due to
NoncomplianceNoncompliance MonthMonth Pts Discontinuing TxPts Discontinuing Tx CostCost
11 200 x 1x $63200 x 1x $63 $12,600$12,60022 50 x 2 x $63 50 x 2 x $63 $ 6,300$ 6,30033 150 x 3 x $63150 x 3 x $63 $28350$2835044 50 x 4 x $6350 x 4 x $63 $12,600$12,60055 50 x 5 x $6350 x 5 x $63 $15,750$15,75066 100 x 6 x $63100 x 6 x $63 $37,800$37,80077 50 x 7 x $6350 x 7 x $63 $22,050$22,050TOTAL COSTSTOTAL COSTS $135,450$135,450
Examples of Innovative Examples of Innovative Pharmacy ServicesPharmacy Services
OsteoporosisOsteoporosis Cardiovascular Cardiovascular
DiseaseDisease Skin DamageSkin Damage Weight Weight
ManagementManagement GlaucomaGlaucoma DiabetesDiabetes
Examples of Innovative Examples of Innovative Pharmacy ServicesPharmacy Services
ImmunizationsImmunizations AsthmaAsthma Smoking CessationSmoking Cessation HypertensionHypertension Alzheimer’sAlzheimer’s DepressionDepression Urinary IncontinenceUrinary Incontinence
How many have had these types How many have had these types of services provided by their of services provided by their
pharmacist?pharmacist?
The Pharmacist’s Role in Disease The Pharmacist’s Role in Disease Prevention and ManagementPrevention and Management
Perform patient risk assessment and Perform patient risk assessment and health screeninghealth screening– Identify patients at riskIdentify patients at risk– Support compliance and adherence to Support compliance and adherence to
prescribed medication and behavioral prescribed medication and behavioral therapiestherapies
Deliver patient education on disease Deliver patient education on disease prevention and disease management prevention and disease management strategiesstrategies
The Pharmacist’s Role in Disease The Pharmacist’s Role in Disease Prevention and ManagementPrevention and Management
Refer to physician for follow-upRefer to physician for follow-up– Physician provides diagnosis and Physician provides diagnosis and
prescribes therapyprescribes therapy Pharmacist monitors drug therapyPharmacist monitors drug therapy
– Provides ensures compliance and Provides ensures compliance and adherenceadherence
– Immediate interventions when problems Immediate interventions when problems are identifiedare identified
Identifying Individuals at Identifying Individuals at RiskRisk
80% of the population with osteoporosis is 80% of the population with osteoporosis is undiagnosedundiagnosed
50% of the 2 million Americans with 50% of the 2 million Americans with glaucoma are unaware that they have the glaucoma are unaware that they have the diseasedisease
33% of diabetics are unaware of their 33% of diabetics are unaware of their conditioncondition
65% of patients with high cholesterol are 65% of patients with high cholesterol are unaware until their first cardiac eventunaware until their first cardiac event
The Importance of The Importance of Professional CollaborationProfessional Collaboration
Less than 1% of physicians in the US are Less than 1% of physicians in the US are involved in preventive care programsinvolved in preventive care programs– Time constraintsTime constraints– Financial incentivesFinancial incentives
Pharmacists become a referral source for Pharmacists become a referral source for physicians physicians
Improved cooperation and information Improved cooperation and information flow improves patient careflow improves patient care