Innovative Pharmacy ServicesInnovative Pharmacy Services

Jann B. Skelton, RPh, MBAJann B. Skelton, RPh, MBA

Vice President of OperationsVice President of Operations

MEDICAMEDICA

The BIG Picture….The BIG Picture….

Project ImPACT: HyperlipidemiaProject ImPACT: Hyperlipidemia

National demonstration project of the APhA National demonstration project of the APhA FoundationFoundation

Deployed in 29 Pharmacies across 14 statesDeployed in 29 Pharmacies across 14 states Over 600 patients enrolledOver 600 patients enrolled

Sponsored through an unrestricted grant from Merck and Co.Sponsored through an unrestricted grant from Merck and Co.

Hyperlipidemia

Project ImPACT: HyperlipidemiaProject ImPACT: HyperlipidemiaRationaleRationale

Hyperlipidemia is a modifiable risk factor in coronary Hyperlipidemia is a modifiable risk factor in coronary heart diseaseheart disease

Pharmacists services are widely accessiblePharmacists services are widely accessible Evidence suggest that pharmacists can improve both Evidence suggest that pharmacists can improve both

compliance and outcomescompliance and outcomes A point-of-care testing device, the Cholestech LDX A point-of-care testing device, the Cholestech LDX

Analyzer is available to pharmacists with patient results Analyzer is available to pharmacists with patient results available in 5 minutesavailable in 5 minutes

The management of cholesterol disorders represents a The management of cholesterol disorders represents a major benchmark by which health care quality can be major benchmark by which health care quality can be evaluatedevaluated

Current Detection and TreatmentCurrent Detection and Treatment

The majority of patients with lipid disorders The majority of patients with lipid disorders are often not identified and not treated.are often not identified and not treated.

On average, only...On average, only...– 35% of patients are diagnosed35% of patients are diagnosed– 32% of patients are prescribed a diet32% of patients are prescribed a diet– 12% of qualifying patients are prescribed a 12% of qualifying patients are prescribed a

drugdrug

Adapted from Am J Cardiol 1998; 82:61-5

Financial Burden of CADFinancial Burden of CADestimated in billions of dollarsestimated in billions of dollars

0 10 20 30 40 50

Home Health

Medications

Physicians

Hospitalizations

Simons, et al MJA 1996; 164:208

n = 610

Patients Discontinuing TherapyPatients Discontinuing Therapy

0

10

20

30

40

50

60

70

80

90

100

0 1 2 3 4 5 6 7 8 9 10 11

Months on lipid lowering therapy

% o

f p

atie

nts

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th

erap

y

Adherence ComparisonAdherence Comparison

0 1 2 3 4 5 6 7 8 9 10 11

0

20

40

60

80

100

% o

f p

ati

en

ts o

n t

he

rap

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Months on lipid lowering therapy

Existing Delivery System

Project ImPACT Model

Hyperlipidemia

MJA 1996; 164:208, JAPhA 1998; 38:529-34.

Medication Waste Costs for 1000 Medication Waste Costs for 1000 Patients in a Health Plan due to Patients in a Health Plan due to

NoncomplianceNoncompliance MonthMonth Pts Discontinuing TxPts Discontinuing Tx CostCost

11 200 x 1x $63200 x 1x $63 $12,600$12,60022 50 x 2 x $63 50 x 2 x $63 $ 6,300$ 6,30033 150 x 3 x $63150 x 3 x $63 $28350$2835044 50 x 4 x $6350 x 4 x $63 $12,600$12,60055 50 x 5 x $6350 x 5 x $63 $15,750$15,75066 100 x 6 x $63100 x 6 x $63 $37,800$37,80077 50 x 7 x $6350 x 7 x $63 $22,050$22,050TOTAL COSTSTOTAL COSTS $135,450$135,450

Examples of Innovative Examples of Innovative Pharmacy ServicesPharmacy Services

OsteoporosisOsteoporosis Cardiovascular Cardiovascular

DiseaseDisease Skin DamageSkin Damage Weight Weight

ManagementManagement GlaucomaGlaucoma DiabetesDiabetes

Examples of Innovative Examples of Innovative Pharmacy ServicesPharmacy Services

ImmunizationsImmunizations AsthmaAsthma Smoking CessationSmoking Cessation HypertensionHypertension Alzheimer’sAlzheimer’s DepressionDepression Urinary IncontinenceUrinary Incontinence

How many have had these types How many have had these types of services provided by their of services provided by their

pharmacist?pharmacist?

The Pharmacist’s Role in Disease The Pharmacist’s Role in Disease Prevention and ManagementPrevention and Management

Perform patient risk assessment and Perform patient risk assessment and health screeninghealth screening– Identify patients at riskIdentify patients at risk– Support compliance and adherence to Support compliance and adherence to

prescribed medication and behavioral prescribed medication and behavioral therapiestherapies

Deliver patient education on disease Deliver patient education on disease prevention and disease management prevention and disease management strategiesstrategies

The Pharmacist’s Role in Disease The Pharmacist’s Role in Disease Prevention and ManagementPrevention and Management

Refer to physician for follow-upRefer to physician for follow-up– Physician provides diagnosis and Physician provides diagnosis and

prescribes therapyprescribes therapy Pharmacist monitors drug therapyPharmacist monitors drug therapy

– Provides ensures compliance and Provides ensures compliance and adherenceadherence

– Immediate interventions when problems Immediate interventions when problems are identifiedare identified

Identifying Individuals at Identifying Individuals at RiskRisk

80% of the population with osteoporosis is 80% of the population with osteoporosis is undiagnosedundiagnosed

50% of the 2 million Americans with 50% of the 2 million Americans with glaucoma are unaware that they have the glaucoma are unaware that they have the diseasedisease

33% of diabetics are unaware of their 33% of diabetics are unaware of their conditioncondition

65% of patients with high cholesterol are 65% of patients with high cholesterol are unaware until their first cardiac eventunaware until their first cardiac event

The Importance of The Importance of Professional CollaborationProfessional Collaboration

Less than 1% of physicians in the US are Less than 1% of physicians in the US are involved in preventive care programsinvolved in preventive care programs– Time constraintsTime constraints– Financial incentivesFinancial incentives

Pharmacists become a referral source for Pharmacists become a referral source for physicians physicians

Improved cooperation and information Improved cooperation and information flow improves patient careflow improves patient care