Analysis of Pharmacists’ Work in a Collaborative Model
What are the components of pharmacists’ work in the management of hypertension in a physician-pharmacist collaborative model?
The CAPTION (Collaboration Among Pharmacists & Physicians To Improve Outcomes Now) trial was a cluster randomized, prospective trial comparing a physician-pharmacist collaborative model with usual care to improve blood pressure control and resolve drug-related problems. Pharmacists during this study completed a clinical-encounter form following each patient interaction. This form was used to obtain information for a descriptive a priori analysis of the pharmacists’ work in the CAPTION trial.
The original CAPTION trial included 390 patients with at least 1 pharmacist intervention. The population was mostly from racial or ethnic minority groups (58%), and a large percentage was of low socioeconomic status. Over 50% had diabetes or chronic kidney disease. The authors found that pharmacists provided 1,214 drug-therapy problem resolutions to patients (e.g., medication adherence and lifestyle change). Pharmacists recommended an additional 1,169 drug-therapy problem resolutions to physicians, of which 98.6% were accepted by the physician. The most common recommendations made to the physician were to start a new antihypertensive (n = 483), increase the antihypertensive dose (n = 329), discontinue antihypertensive medication (n = 283), and decrease the antihypertensive dose (n = 94). The pre-visit work for the pharmacists averaged 4.05 minutes per encounter, and post-visit work (e.g., documentation, presenting recommendations, and care coordination) averaged 8.85 minutes per encounter. The time spent on pre- and post-visit work accounted for 31% of the pharmacists’ work. The average time spent per patient for the initial and follow-up encounters were similar: 33 minutes and 28 minutes, respectively. In total, pharmacists spent an average of 4.99 hours per patient over the 9-month study period. After an average of 6.2 follow-up encounters per patient, the result was an improvement of blood pressure goal attainment from 0% at baseline to 43% at study end. Additionally, the Data and Safety Monitoring Board determined no significant difference in the rate of adverse events between the intervention and control groups.
Pharmacists in physician-pharmacist collaborative models make significant contributions to the management of patients with hypertension. These data provide a value proposition for integrating pharmacists into new value-based models of care that focus on population health.
This is one of the first studies to evaluate pharmacists’ workload and relative value in a physician-pharmacist collaborative model. As the Centers for Medicare and Medicaid Services looks toward quality-based bundle-payment models, it will be critical to determine individual contributions of each member of the team. The clinical benefit of physician-pharmacist collaborative models is becoming increasingly clear, but additional research is needed to better understand how to implement pharmacists into such models so that they are adequately compensated for their contributions to the health care team and patient care.
Keywords: Antihypertensive Agents, Blood Pressure, Centers for Medicare and Medicaid Services (U.S.), Diabetes Mellitus, Hypertension, Life Style, Medication Adherence, Metabolic Syndrome X, Minority Groups, Patient Care, Patient Care Team, Pharmacists, Physicians, Renal Insufficiency, Chronic
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