1. 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

2. Outline
Background
Methods
Results
Limitations
Discussion
Conclusion

3. Background

4. 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

5. 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

6. Methods

7. 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

8. 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

9. 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

10. Results

11. 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.

12. 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

13. 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

14. Limitations

15. 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

16. Discussion

17. 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)

18. 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

19. Conclusion

20. 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.

21. What questions do you have?