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Care Coordination

Poor communication and care coordination are barriers that impede medication management across settings of care. Clinical pharmacy services that provide primary care, medication review with patients upon discharge, and follow up in the ambulatory setting and appropriately document these critical services in the patient’s medical record can significantly reduce harm, eliminate waste, and improve patient outcomes. Innovative pharmacist-coordinated disease state management programs as a health care or medical home have been shown to result in significantly improved patient outcomes while demonstrating cost savings and improved patient satisfaction.

Examples of Transformational Change

Diabetes Care Collaborative Practice

In another study, pharmacists at two primary care clinics provided diabetes education, initiated or adjusted insulin therapy, and ordered pertinent laboratory tests to monitor patients’ response to therapy. Pharmacists also scheduled patient appointments with physicians, dietitians, social workers and psychologist, when appropriate. Patient—pharmacist interactions occurred face-to-face and by telephone. HbA1c concentrations were decreased from 11.1% to 8.9% (p=0.00004). After subtracting the cost of the pharmacists’ services and medical center charges for the appointment, the study saved the medical center a total of $103,950. See Coast-Senior EA., Kelley CL, Kelley CL, et al. Management of patients with type 2 diabetes by pharmacists in primary care clinics. Ann Pharmacother 1998;32:636-41.

Pharmacist-Run Hypertension Clinic

Another study randomized patients with uncontrolled hypertension to usual care managed by a physician or to physician—pharmacist management in a pharmacist-run hypertension clinic for a period of one year. Pharmacists provided patient education, made treatment recommendations, and provided follow-up utilizing an evidence-based treatment algorithm. While significant reductions in blood pressure were seen in both groups, the intervention group with pharmacist involvement resulted in a significantly greater reduction in blood pressure (p<0.01) and significantly more of these patients reached their blood pressure goal (p<0.02). In addition, average visit costs per patient were significantly lower for the intervention group ($160 vs $195, p=0.04). See Borenstein JE. Physician-pharmacist comanagement of hypertension: a randomized, comparative trial. Pharmacotherapy. 2003;23(2):209-16.

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