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4/7/2004

Wyoming Program Brings Pharmacist Consultations Home

Kate Traynor

Thanks to a program created by Wyoming lawmakers last year, state residents can pay a nominal fee to meet face-to-face with a pharmacist to look for ways to save money on medications and avoid possible adverse drug events.

Officially named the Pharmacy Technical Assistance Program but popularly termed Wyoming PharmAssist, the project was created by the state legislature last July and became active in December. The program is run through the Wyoming Department of Health, which has partnered with pharmacists on the faculty of the University of Wyoming School of Pharmacy to conduct the consultations.

Medication Review Catches on in Wyoming

A research-oriented program that shares some elements with PharmAssist is getting off the ground and aims to begin helping Wyoming seniors by this fall.

Like PharmAssist, the research project brings together patients—Wyoming seniors, in this case—and pharmacists for an intensive medication-review session, for which the pharmacist receives a $75 fee.

But one difference between the two programs is the way the pharmacists' recommendations are presented to the prescriber.

"My patients have to take the information to their physicians. We don't send it" to them, said Linda Gore Martin, an assistant professor of social and administrative pharmacy at the University of Wyoming School of Pharmacy who leads the project.

Martin said that having the patients take an active role in discussing medication changes with their physicians empowers patients, giving them a sense of control over medication-use decisions.

Pharmacists who participate in Martin's project will use a medication appropriateness index and cognitive assessment tool to record data from seniors during the counseling sessions.

Ultimately, Martin said, she hopes to use the assessments to create a scale that measures the appropriateness of a patient's medication regimen and indicates a point at which intervention is needed.

Martin said that recruiting pharmacists to perform the medication reviews is challenging, because the work is done outside of a pharmacist's regular employment, but the recruits are looking forward to the project.

"A couple of them have said that they're very excited about being able to do this [live counseling], because they don't get to do enough of it in their regular jobs," she said.

Each medication review brings the consulting pharmacist $70 in state funds plus a $5 fee that is collected from the client.

Although only a handful of residents have completed their consultation, the initial results appear to be dramatic.

"What we've found is an average yearly saving of about $1200," said Aimee Lewis, a consultant pharmacist at the state department of health.

Lewis said that some clients were not candidates for major cost-saving changes but received other help from the program. "We've had a couple of pharmacists who have filled out the initial paperwork to get [clients] onto the drug manufacturer programs," she explained.

PharmAssist is currently active in four areas in the eastern half of the state-Casper, Cheyenne, Laramie, and Torrington—and may expand to other regions by this summer.

"We started in places where we had University [of Wyoming] School of Pharmacy faculty," said Kendra Grande, coordinator of the pharmacy school's drug information center. "That's how I got involved."

Grande, who works in Laramie, said that people who are interested in a medication review call a toll-free number at the pharmacy school, which sends the potential client an information packet to complete and send to the health department.

"The packet is basically their drug history and their medical information, their doctors' names, their pharmacies, all their disease states, and just basically everything we would need to evaluate their medications," including herbal products and nonprescription medications, Grande said.

After reviewing the packet, a pharmacist sets up a face-to-face meeting with the client, which may take place at the pharmacist's workplace or the client's home.

"The timing and the location, we're really leaving up to them," Lewis said. "They do, obviously, have other full-time jobs," she said of the participating pharmacists.

Grande said she typically allots about an hour and a half for the consultation. "We review for all of the typical things that you would look for as a pharmacist—any sort of adverse effects or therapeutic duplications," she said. Questions to consider, she added, include, "is there something we can eliminate, or are we treating a side effect of a drug with another drug?"

For cost-saving ideas, she said, she suggests clients take generic alternatives to brand-name products when possible. Sometimes, she added, a switch to a nonprescription medication makes sense. "If they're on a prescription proton-pump inhibitor," Grande said, "I'll talk to them about going to an H2-blocker or switching to over-the-counter Prilosec, which is less expensive."

In some cases, such as when a woman has been receiving long-term hormone replacement therapy, the pharmacist suggests eliminating the drug from the patient's regimen. "That's a fairly easy one," Grande said. "Pretty much, whenever we see that, it's one that can be closed out."

Sometimes, Lewis said, the consultation reveals a need for additional medical care that could drive up medication costs.

"Our pharmacists are also recommending things like pneumonia shots if [a client has] never received one [or] recommending baby aspirin when it's necessary, flu shots, that sort of thing," she said. "We want to save money on medications, but we want to make sure the quality of care is of the best standard we can possibly have. Sometimes that means adding medications instead of taking things away."

After the consultation, the pharmacist writes a letter to the client's physician outlining the suggested medication changes. No data are available yet on whether physicians are adopting the recommendations, but Lewis said that a survey of clients and their physicians is planned to track how well PharmAssist is working for residents.

The first progress report on Pharm­Assist is due to the state legislature by October 1, 2004.