OBJECTIVE: To determine the effect of 3 alternative models of ambulatory-care pharmacist consultation on patient survival and hospitalization. STUDY DESIGN: Patients were randomly chosen adult Kaiser Permanente (KP) Southern California enrollees with at least 1 prescription in the base year. The demonstration lasted 23 months. Using time-dependent proportional hazards estimation, survival and hospitalization were examined across 5 patient risk groups. INTERVENTIONS: The pharmacy interventions were (1) consultation about new or changed prescriptions as mandated by 1992 state and federal regulations (State model), (2) consultation focused on selected high-risk ambulatory care patients (KP model), and (3) pre-1992 standard care (Control model). RESULTS: In the 6 service areas in which only 1 of the models was implemented, both the KP (relative risk [RR] = 0.295, P < .001) and State (RR = 0.338, P < .001) models significantly reduced emergency hospital admissions over 2 years compared with the Control model when measured across all risk groups. The State model also was associated with fewer urgent and emergency admissions (RR = 0.854, P < .001). In the randomized treatment sample of 5499 patients, the KP model was associated with lower total mortality per new prescription filled (RR = 0.921, P < .01), and significantly lower hospitalization and mortality in high-risk patient groups. CONCLUSIONS:Intensive outpatient pharmacist consultation targeting high-risk patients would improve survival and decrease hospitalization rates. Broader nontargeted consultation would reduce hospitalizations, but was not associated with lower mortality within the 2-year intervention.
RCT Entities:
OBJECTIVE: To determine the effect of 3 alternative models of ambulatory-care pharmacist consultation on patient survival and hospitalization. STUDY DESIGN:Patients were randomly chosen adult Kaiser Permanente (KP) Southern California enrollees with at least 1 prescription in the base year. The demonstration lasted 23 months. Using time-dependent proportional hazards estimation, survival and hospitalization were examined across 5 patient risk groups. INTERVENTIONS: The pharmacy interventions were (1) consultation about new or changed prescriptions as mandated by 1992 state and federal regulations (State model), (2) consultation focused on selected high-risk ambulatory care patients (KP model), and (3) pre-1992 standard care (Control model). RESULTS: In the 6 service areas in which only 1 of the models was implemented, both the KP (relative risk [RR] = 0.295, P < .001) and State (RR = 0.338, P < .001) models significantly reduced emergency hospital admissions over 2 years compared with the Control model when measured across all risk groups. The State model also was associated with fewer urgent and emergency admissions (RR = 0.854, P < .001). In the randomized treatment sample of 5499 patients, the KP model was associated with lower total mortality per new prescription filled (RR = 0.921, P < .01), and significantly lower hospitalization and mortality in high-risk patient groups. CONCLUSIONS: Intensive outpatient pharmacist consultation targeting high-risk patients would improve survival and decrease hospitalization rates. Broader nontargeted consultation would reduce hospitalizations, but was not associated with lower mortality within the 2-year intervention.
Authors: Robby Nieuwlaat; Nancy Wilczynski; Tamara Navarro; Nicholas Hobson; Rebecca Jeffery; Arun Keepanasseril; Thomas Agoritsas; Niraj Mistry; Alfonso Iorio; Susan Jack; Bhairavi Sivaramalingam; Emma Iserman; Reem A Mustafa; Dawn Jedraszewski; Chris Cotoi; R Brian Haynes Journal: Cochrane Database Syst Rev Date: 2014-11-20
Authors: Christine Y Lu; Dennis Ross-Degnan; Stephen B Soumerai; Sallie-Anne Pearson Journal: BMC Health Serv Res Date: 2008-04-07 Impact factor: 2.655