Early Reports on Iowa Pharmaceutical Case Management Seem Encouraging
PCM was authorized by the state legislature in 1999 and implemented in October 2000.
The federal Health Care Financing Administration approved PCM services through an amendment to the state Medicaid plan. Researchers from the University of Iowa will measure the clinical and fiscal impacts of PCM and present a final report to the legislature in December 2002.
"We are very excited about the information weve gathered about services during the projects first quarter," said pharmacist Nancy Bowersox, vice president, clinical pharmacy services, at the Iowa Pharmacy Association (IPA). Survey responses from 86% of the participating pharmacies indicated that pharmacists had met with and evaluated more than 30% of the eligible patients.
The Iowa Department of Human Services identified 1561 patients in the projects first quarter and 540 additional patients in the second quarter. To qualify for PCM services, patients must have at least 1 of 12 diseases, be using at least four regularly scheduled nontopical prescription drugs, and be receiving medications from PCM-eligible pharmacies.
Physicianpharmacist teams may work with patients in their practices who are identified as eligible for PCM services. PCM does not involve collaborative practice agreements but features loosely structured teams consisting of the patients usual primary care providers. The pharmacist invites the patient to participate and contacts the physician, and the team decides which services would benefit the patient. Both providers are paid at the same rates: $75 for initial assessment, $40 for new problem assessment, $40 for problem follow-up assessment, and $25 for preventive follow-up assessment.
"Were thrilled," said Bowersox, that the PCM initiative recognizes pharmacists as individual providers.
Participating pharmacies are required to have private patient consultation areas and problem-oriented, longitudinal patient record systems and to meet other criteria. Eligible pharmacists must be employed at participating pharmacies and present evidence of their ability to provide patient care (see September 15, 2000, AJHP News).
Pharmacies associated with several health systems are participating, said Bowersox, including the Mercy network of pharmacies in the Dubuque and Mason City areas, pharmacies affiliated with the Covenant system in Waterloo, and the John Deere Pharmacy Group in Waterloo.
Survey results indicate that in the programs first quarter only 11% of patients and 7% of physicians had declined to participate. More frequently, patients identified as eligible were not participating because their circumstances had changed (e.g., they had moved or been admitted to nursing homes) or because of pharmacy staffing issues. At an IPA educational meeting in January, participants exchanged tips on how to overcome barriers to the success of the program.
As PCM entered its second quarter, a preliminary report to the legislature included several success stories (box).
Praise for PCM
Also included was a letter to a pharmacist from a patient that read, in part:
I want to thank you so much for the study you did on my medication. Because you did this and talked to Dr. _______, he did a series of [tests] and found that I have a serious blood problem . Had it not been for you, we might not have found out about this for some time.