IMPACT OF PHARMACIST DELIVERED CARE IN THE COMMUNITY PHARMACY SETTING LEXI THUMANN, NICHOLE NUNEMAKER, PAUL SCHOLBROCK, KIRSTEN WELLS, DR. JAY CURRIE Impact of Pharmacist Delivered Care in the Community Pharmacy Setting

Outline Background Methods Results Limitations Discussion Conclusion

Background

Background Lack of systematic reviews evaluating the outcomes of pharmacist delivered care in the community pharmacy setting Having reliable data from controlled trials is important as community pharmacies move forward in advancing clinical services and medication management -There is a lack of systematic reviews evaluating the outcomes of pharmacist delivered care in the community pharmacy setting -This could be CMRs, MTMs, extra counseling services for at risk patients, etc. -Having reliable data from controlled trials is important as pharmacies move forward in advancing clinical services and medication management in community pharmacies

Purpose Systematically analyze primary literature to determine the impact of expanded pharmacist services in community pharmacy Analyze 3 specific outcomes: Clinical Economic Patient satisfaction Determine what future research is needed in this area

Methods

Methods Systematic review of primary literature PubMed search: “community pharmacy services AND (economics OR clinical outcomes OR patient satisfaction)” Results were narrowed down to clinical trials only Inclusion and exclusion criteria (next slide) Each article read and analyzed by 2 team members Every article entered into a chart Analysis of results of the articles we did not exclude 2 people analyzing-to avoid personal bias. 2 sets of eyes reading each article allows more accurate results. Any discrepancies between the 2 people were discussed and a 3rd person would analyze the article to make a final decision. Chart-also includes the excluded articles and the reason for excluding them

Inclusion Criteria Exclusion Criteria Community pharmacy Historical/parallel control groups Published in a peer reviewed journal Primary literature Clinical, economic or patient satisfaction outcomes Interaction involves a pharmacist interaction with the patient whether by phone or face to face interaction Pharmacist intervention Not in a community pharmacy No control Not a peer reviewed article Secondary and tertiary literature No clear outcome No full text Pilot studies and study protocols Not a pharmacist intervention For the purposes of the study, a pharmacy was considered a community pharmacy if anyone in the public could walk up and get their prescription filled there. Peer reviewed articles: (e.g. JAMA, NEJM, JAPhA) Primacy literature: Randomized controlled trials, longitudinal trials, historical trials Secondary/tertiary literature: Review articles, meta analysis, systematic reviews

Methods Cont. Data abstracted from each article: Peer reviewed journal Objective of article Study design Setting Sample size Intervention Outcome measures Results Sources of bias Limitations

Results

Results Literature search on Pubmed found 220 articles 43 articles met our inclusion criteria 19 addressed clinical outcomes 1 addressed economic outcomes 3 addressed patient satisfaction outcomes 5 addressed both clinical and economic outcomes 9 addressed both clinical and patient satisfaction outcomes 1 addressed both economic and patient satisfaction outcomes 5 addressed all three outcomes Clinical outcomes were measured using parameters like HbA1c and blood pressure when assessing interventions dealing with diabetes control or blood pressure management, respectively. Economic outcomes typically utilized insurance claims. Patient satisfaction measures were for the most part evaluated through patient completed surveys or telephone interviews of the patient experience As you can see, the articles we evaluated mostly focused on clinical outcomes and a gap in the literature exists in articles focusing on economic or patient satisfaction outcomes.

Results Cont. 177 articles were excluded 95 did not take place in a community pharmacy 5 did not have a clear intervention 26 had an intervention that was not done by a pharmacist 31 had an intervention that was not related to clinical, economic, or patient satisfaction outcomes 12 had no full text available 31 were a study protocol or pilot study Interventions that weren’t done by a pharmacist included electronic interventions (e.g. testing new software, an adherence tool or ad services) interventions that tested 2 treatment strategies (e.g. comparing different drugs, weight loss strategies, etc.) and interventions that were done on the pharmacist rather than the patient **number of excluded articles in each category adds up to more than 177 because some articles were excluded for more than one reason

Number of articles with a statistically significant positive outcome Results Cont. Outcome Number of articles with a statistically significant positive outcome Clinical 22 Economic 4 Patient Satisfaction 13

Limitations

Limitations PubMed vs. other databases In a perfect world, we would have time to look through every article referenced by the articles we included Strict Inclusion Criteria Search strategy probably didn’t find all the available literature relating to our study (only searched PubMed, might have found better articles using another database or different search terms) Strict Inclusion Criteria -Very particular about what is considered a community pharmacy

Discussion

What Was Done Well Interventions that led to statistically significant positive outcomes: Taking specific clinical measurements (ex: A1C, BP) and using them to educate patients and recommend drug therapy changes to prescribers Extensive training (ex: training on blood glucose meters, insulin injection technique, providing education manuals)

Future Research Needed Problems identified with studies that were included but did not show a statistically significant improvement in outcomes: Low power Low response rate from physicians to pharmacist requests Lack of studies looking at economic outcomes Low power-low sample size Lack of studies looking at economic outcomes- Some showed outcomes looking at things like reduced hospital stays, reduced missed work days but did not relate that to cost, even though these outcomes would indirectly have an economic effect

Conclusion

Main take away Discuss gap in literature when it comes to research evaluating economic outcomes as this is going to be the main driver in moving towards provider status and pharmacist’s billed services.

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