title: Effects of ambulatory-care pharmacist consultation on mortality and hospitalization.
abstract: OBJECTIVE
  To determine the effect of 3 alternative models of ambulatory-care pharmacist consultation on patient survival and hospitalization.
  
  
  METHODS
  Patients were randomly chosen adult Kaiser Permanente (KP) Southern California enrollees with at least 1 prescription in the base year. The demonstration lasted 23 months. Using time-dependent proportional hazards estimation, survival and hospitalization were examined across 5 patient risk groups.
  
  
  METHODS
  The pharmacy interventions were (1) consultation about new or changed prescriptions as mandated by 1992 state and federal regulations (State model), (2) consultation focused on selected high-risk ambulatory care patients (KP model), and (3) pre-1992 standard care (Control model).
  
  
  RESULTS
  In the 6 service areas in which only 1 of the models was implemented, both the KP (relative risk [RR] = 0.295, P < .001) and State (RR = 0.338, P < .001) models significantly reduced emergency hospital admissions over 2 years compared with the Control model when measured across all risk groups. The State model also was associated with fewer urgent and emergency admissions (RR = 0.854, P < .001). In the randomized treatment sample of 5499 patients, the KP model was associated with lower total mortality per new prescription filled (RR = 0.921, P < .01), and significantly lower hospitalization and mortality in high-risk patient groups.
  
  
  CONCLUSIONS
  Intensive outpatient pharmacist consultation targeting high-risk patients would improve survival and decrease hospitalization rates. Broader nontargeted consultation would reduce hospitalizations, but was not associated with lower mortality within the 2-year intervention.
authors.affiliation: Global Epidemiology Outcomes Research, Bristol-Myers Squibb, Princeton, NJ, USA.
authors.forename: Yong
authors.initials: Y
authors.lastname: Yuan
authors.forename: Joel W
authors.initials: JW
authors.lastname: Hay
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: McCombs
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D002140:California / Q000453:epidemiology; D011307:Drug Prescriptions; D006279:Health Maintenance Organizations / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D006302:Health Services Research; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007885:Legislation, Pharmacy; D017146:Models, Organizational; D009026:Mortality; D010349:Patient Compliance; D010353:Patient Education as Topic / Q000331:legislation & jurisprudence*; D015397:Program Evaluation; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012017:Referral and Consultation / Q000331:legislation & jurisprudence*; D018570:Risk Assessment; D012494:Sampling Studies; D016019:Survival Analysis