Tasha Woodall1, Suzanne E Landis2, Shelley L Galvin2, Tim Plaut2, Mary T Roth McClurg3. 1. Mountain Area Health Education Center, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, Hendersonville Road, Asheville, NC tasha.woodall@mahec.net. 2. Mountain Area Health Education Center, University of North Carolina School of Medicine, Chapel Hill, NC. 3. UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Abstract
PURPOSE: The effectiveness and financial benefit of pharmacist-led annual wellness visits (AWVs) in conjunction with comprehensive medication management (CMM) for older, high-risk patients were examined. METHODS: Eligible patients were 65 years of age or older with three or more chronic medical conditions, taking five or more long-term prescription or nonprescription medications and receiving primary care in a retirement community clinic. The intervention involved two components, an AWV and CMM. The AWV included all Medicare-required components. All participants saw a clinical pharmacist practitioner for an AWV with CMM and additional CMM visits at three and six months. Outcomes included completion of required AWV components, prevalence of medication-related problems (MRPs), classic return on investment, patient satisfaction, and change in rate of hospitalization. RESULTS: Of the 60 eligible patients contacted, 53 (88%) agreed to participate. Patients' mean ± S.D. age was 82.1 ± 5.5 years, and patients used a median of 12 medications (range, 5-27) at baseline. The pharmacist identified at least 1 MRP in 90.6% of patients at the AWV; all patients had at least 1 MRP identified over six months. A total of 278 MRPs were identified: suboptimal drug (32.7%), insufficient therapeutic monitoring (25.2%), undertreatment of chronic condition (16.9%), and suboptimal dose, frequency, or administration (15.8%). Revenue generated by the pharmacist exceeded costs by 38.1%. The rate of hospitalizations did not significantly change after the intervention. CONCLUSION: Pharmacists played a beneficial role in the provision of both AWVs and CMM, facilitating the completion of wellness visits and identifying and addressing MRPs in an older, high-risk population.
PURPOSE: The effectiveness and financial benefit of pharmacist-led annual wellness visits (AWVs) in conjunction with comprehensive medication management (CMM) for older, high-risk patients were examined. METHODS: Eligible patients were 65 years of age or older with three or more chronic medical conditions, taking five or more long-term prescription or nonprescription medications and receiving primary care in a retirement community clinic. The intervention involved two components, an AWV and CMM. The AWV included all Medicare-required components. All participants saw a clinical pharmacist practitioner for an AWV with CMM and additional CMM visits at three and six months. Outcomes included completion of required AWV components, prevalence of medication-related problems (MRPs), classic return on investment, patient satisfaction, and change in rate of hospitalization. RESULTS: Of the 60 eligible patients contacted, 53 (88%) agreed to participate. Patients' mean ± S.D. age was 82.1 ± 5.5 years, and patients used a median of 12 medications (range, 5-27) at baseline. The pharmacist identified at least 1 MRP in 90.6% of patients at the AWV; all patients had at least 1 MRP identified over six months. A total of 278 MRPs were identified: suboptimal drug (32.7%), insufficient therapeutic monitoring (25.2%), undertreatment of chronic condition (16.9%), and suboptimal dose, frequency, or administration (15.8%). Revenue generated by the pharmacist exceeded costs by 38.1%. The rate of hospitalizations did not significantly change after the intervention. CONCLUSION: Pharmacists played a beneficial role in the provision of both AWVs and CMM, facilitating the completion of wellness visits and identifying and addressing MRPs in an older, high-risk population.