The impact of a pharmacotherapy consultation on the cost and outcome of medical therapy.
BACKGROUND
One important task for physicians is to optimize their patients' medication regimen. Involvement of clinical pharmacists who have specific training in drug regimen design has been associated with improved patient outcomes for specific medical conditions, eg, hypertension and anticoagulation. This prospective, randomized trial investigated whether a single consultation by a clinical pharmacist with high-risk patients and their primary physicians would result in improved prescribing outcomes.


METHODS
Patients at risk for medication-related problems were identified and randomized to receive a pharmacotherapy consultation (consult group) or usual medical care (control group). Outcomes, including the number of drugs, number of doses per day, cost of medications, and patient reports of adverse effects, were recorded at baseline and at 6 months following the intervention.


RESULTS
Fifty-six subjects were evaluable: 29 in the control group, and 27 in the consult group. Six months after the consultation, the number of drugs, the number of doses, and the 6-month drug costs all decreased in the consult group and increased in the control group; the net difference was 1.1 drugs (P = .004), 2.15 doses per day (P = .007), $586 per year (P = .008). The side effects score improved by 1.8 points more in the consult group compared with the control group (P = NS). Similarly, the prescribing convenience score in the consult group improved by 1.4 points more than that of the control group (P = NS).


CONCLUSIONS
This study demonstrates several important benefits of integration of a clinical pharmacist into a primary care setting, including improvement in cost and simplification of the medication regimen with no reduction in quality of care.
Jameson
J
J
College of Pharmacy, Ferris State University, Big Rapids, Michigan, USA.
VanNoord
G
G
Vanderwoud
K
K
D000553:Ambulatory Care; D016527:Drug Costs; D004358:Drug Therapy / Q000191:economics / Q000706:statistics & numerical data; D064420:Drug-Related Side Effects and Adverse Reactions; D005194:Family Practice / Q000191:economics; D005260:Female; D006801:Humans; D008297:Male; D008824:Michigan; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010601:Pharmacology, Clinical; D011446:Prospective Studies; D012017:Referral and Consultation / Q000191:economics