The Growth in Pharmaceutical Care

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The Growth in Pharmaceutical Care U.S. Medicine
Institute for Health Studies June 27, 2003 John
F. Derr, R.Ph. American Health Care Association
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Pharmaceutical Care

• Pharmacists medication therapy management
  services help to eliminate unnecessary or
  counterproductive treatments, assure that
  patients are receiving the most appropriate drug
  therapy for their medical conditions, and help
  patients adhere to what often are complicated
  medication regimens.
• Statement to The finance Committee U.S. Senate
  June 6, 2003 Pharmacist Provider Coalition

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Continuum of Senior Care
AHCA
4
Growth in Number of People Over 65
From 2000 to 2030 34M to 70M in 30 years a 105
increase
From 1970 to 2000 20M to 34M in 30 years a 70
increase
Source U.S. Census Bureau The Consultant
Pharmacist July 2000 Page 704
AHCA
5
Life Expectancy at Age 65
AHCA
6
Age Of Residents In Nursing Home
Source American Health Association, Facts and
Trends The Nursing Facility Sourcebook The
battle for market share by Jim Moore
Contemporary Long Term Care October 1999
AHCA
7
Population vs. Workforce
AHCA
8
Rx Use and Seniors

• 28.5 Rxs/year - 2000
• 45 increase in utilization since 1992
• Projected 2010 utilization - 38.5 Rxs/year
• 2010 utilization 35 over 2000

SeniorUtilizationRxs/year
Source Families USA/Prime Institute July 2000
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Percent Using Prescriptions
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Average Number of Prescriptions Filled/Year
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• The Problem
• Medication-Related
• Morbidity and Mortality

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Why Medication-Related Morbidity and Mortality?

• Medication therapy represents the most common
  form of treatment in contemporary health care.
• Medication-related morbidity and mortality is a
  major public health concern that requires expert
  attention.
• Its where pharmacists can make a difference50
  of MRMMs are preventable.

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Adverse Drug Events in Nursing Homes

• 51 of ADEs are preventable
• Ordering and monitoring errors most common
• Psychoactive medications and anticoagulants most
  commonly associated with preventable ADEs

Gurwitz JH et al, Am J Med, 2000.
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Medication Related Problem Costs

• 76.6 B - Ambulatory care1
• 20.0 B - Acute care2
• 4.0 B - Nursing Home care3
• 100.6 B Medical costs of MRPs

Sources 1 - Bootman L, et al, Arch Internal Med,
1995 2 - Bates, et al, JAMA, 1995
3 - Bootman L, et al, Arch Internal
Med, 1997
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Cost of Medication Related Problems
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AmericasSenior Care Pharmacists
TM
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Drug Therapy Decisions in LTC Drug Regimen Review
"The drug regimen of each patient must be
reviewed at least once a month by a licensed
pharmacist.
The pharmacist must report any irregularities to
the attending physician and the director of
nursing and these reports must be acted upon."
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Senior Care Pharmacy Thru Pharmaceutical Care for
Seniors

• A practice in which the pharmacist takes
  responsibility for a patients medication-related
  needs and is held accountable for this commitment
• Ensures that patients medication therapy is
  appropriate, most effective available, safest
  possible, and is used as indicated
• Accomplished by identifying, resolving, and
  preventing MRPs that interfere with achieving
  therapeutic goals and producing positive outcomes

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Senior Care Pharmacists

• Have specialized knowledge in geriatrics and the
  unique medication related needs of the senior
  population, which they apply in the provision of
  pharmaceutical care
• Senior Care Pharmacy Practice
• Certified Geriatric Pharmacist (CGP)

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Pharmacist Reduces Med Errors
66 Reduction
Source New England Journal of Medicine and
Quality Review Bulletin healthcare business July
2000 Special Supplement
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The Fleetwood ProjectPhase III

• American Society of Consultant Pharmacists (ASCP)

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What is the Fleetwood Project?

• Three-phase initiative to demonstrate the impact
  of consultant pharmacist services on patient
  outcomes and cost
• Started in 1995 as ASCPs highest research
  priority
• Administered by the ASCP Research and Education
  Foundation

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Consultant Pharmacist

• Screen for high risk/inappropriate meds with
  every order
• Pharmacist prospective review of med regimen
• Identify actual/potential MRPs
• Contact prescriber
• Recommendation
• Document in pharmaceutical care plan

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Fleetwood Phase I Results

• Increases the number of patients who experience
  an optimal therapeutic outcome by 43
• Saves 3.6 billion annually in costs from avoided
  MRPs
• 7.6 billion vs 4 billion

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Fleetwood Phase II Results

• The consultant/internal (dispensing) pharmacists
  and pharmacy technicians shifted their focus from
  the drug to the patient
• The internal pharmacists became more confident in
  their clinical skills and knowledge and became
  more involved with clinical decision making

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Fleetwood Phase II Results

• Physicians and nursing staff viewed consultant
  pharmacist as a more integral member of the
  interdisciplinary care team
• Fleetwood Model enhanced communication between
  pharmacy staff, pharmacy and physicians and the
  nursing facilities
• Pharmacy workflow was studied and many processes
  were streamlined for efficiency and duplicate
  steps eliminated

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M-3 Project

• Multidisciplinary Medication Management Project
• American Society of Consultant Pharmacists and
  American Medical Directors Association
• Formed an Advisory Committee to explore
  strategies for improving the use of medications
  in LTC

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Information Systems

• Focus must be on the Resident
• Everyone must be included information available
  accessible
• Ease of Updating Documenting Resident Chart,
  Care Plans, Clinical Findings
• Consistency Accuracy of Information

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Senior Care
Excellent Care to the Elderly
Only the Body Withers by Lucie Bilodeau