Adherence to clinical practice guidelines for 7 chronic conditions in long-term-care patients who received pharmacist disease management services versus traditional drug regimen review.
BACKGROUND
Numerous studies have shown that adherence to published clinical practice guidelines (CPGs) reduces disease morbidity and mortality. However, few benchmarks exist that demonstrate the rate of adherence to CPGs in patients in long-term-care facilities (LTCFs).


OBJECTIVE
To evaluate CPG adherence in patients in LTCFs who received consultation from pharmacists who emphasize disease state management (DSM) compared with patients in other LTCFs who received traditional drug regimen review (DRR).


METHODS
A retrospective chart review was conducted in November 2005 for 107 patients who received DSM services in 2 LTCFs and 304 patients who received DRR services in 4 LTCFs for the service period ending September 30, 2005. Chart review was conducted on all patients included in the current census as of September 1, 2005; residents were excluded from the analysis if they were discharged or deceased between September 1, 2005, and the date of chart review. CPG adherence was evaluated for the following 7 conditions: diabetes, coronary artery disease (CAD), stroke, heart failure (HF), hypertension, hyperlipidemia, and osteoporosis. In addition, the 6 most recent pharmacist recommendations for each patient were classified according to disease state.


RESULTS
Adherence to CPGs was significantly better (all P <0.05) in patients receiving DSM services for the following performance measures for 4 of the 7 disease states: (1) diabetes: antiplatelet or warfarin use or contraindication for use (hypersensitivity or history of serious bleeding event), 89.7% for DSM services versus 71.0% for DRR services, and glycosylated hemoglobin (HbA1c) </- 7% (86.2% vs. 62.0%); (2) CAD: antiplatelet use (88.2% vs. 56.1%), and angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) use (82.4% vs. 40.9%); (3) HF: ACEI or ARB use (73.3% vs. 44.9%); and (4) osteoporosis: calcium use (85.0% vs. 56.3%). These observed differences in CPG adherence rates for patients receiving DSM services remained statistically significant after multivariate adjustment for likely confounders. Adherence to CPGs was not different between DSM and DRR facilities for the other 3 disease states (hypertension, hyperlipidemia, and stroke, P >0.05). The mean number of pharmacist recommendations per patient per month was greater in DSM facilities (0.76) compared with DRR facilities (0.23, P <0.001). Pharmacists who provided DSM consultant services were more likely to make a recommendation to improve DSM (51.6%) than were pharmacists in the comparison facilities who provided traditional DRR services (31.7%, P <0.001).


CONCLUSIONS
This self-evaluation of the provision of pharmacist consultant services that focus on disease management in addition to DRR found a higher rate of adherence to clinical practice guidelines for 4 of 7 common chronic disease states in long-term-care patients compared with patients who received only traditional DRR services.
Horning
Kristin K
KK
University of Iowa College of Pharmacy, Iowa City, USA. HorninKK@ihs.org
Hoehns
James D
JD
Doucette
William R
WR
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D002908:Chronic Disease; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000188:drug therapy; D003695:Delivery of Health Care / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D003920:Diabetes Mellitus / Q000188:drug therapy; D004358:Drug Therapy / Q000592:standards / Q000706:statistics & numerical data*; D017723:Drug Utilization Review / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000188:drug therapy; D006801:Humans; D016015:Logistic Models; D008134:Long-Term Care; D008297:Male; D015999:Multivariate Analysis; D010024:Osteoporosis / Q000188:drug therapy; D010361:Patients / Q000706:statistics & numerical data*; D010595:Pharmacists; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D024382:Professional Role; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use
D000806:Angiotensin-Converting Enzyme Inhibitors; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin