Student-run low-income family medicine clinic: controlling costs while providing comprehensive medication management.
OBJECTIVE
To evaluate the impact of implementing cost-control measures on drug use and financial performance of a student-run safety net clinic and to assess the effect of the measures on patient care.


METHODS
Medication histories and patient information were obtained from the University of Nebraska Medical Center's student-run safety net clinics' (SHARING and GOODLIFE) computer databases and internal medication cost documents for all patients treated with medications at the clinics from April 1, 2006, through March 31, 2008. Main outcome measures were cost, use, and source of all medications and the resultant financial savings between the pre- and post-periods.


RESULTS
200 patients were treated with medications during the 2-year period (164 patients before April 1, 2007, and 137 after). A majority of clinic patients were treated for chronic conditions, including 62% for hypertension, 54% for diabetes, 46% for dyslipidemia, and 26% for depression. The average monthly cost to the clinics for medications decreased from $5,444.87 before April 1, 2007, to $3,714.05 (P = 0.002) after. With these changes, the cost per prescription from any delivery method decreased from $15.28 to $13.02 (P < 0.001) and the average cost per prescription decreased from $27.32 to $20.27 (P < 0.001) after formulary implementation. The number of prescriptions per patient per month was unchanged.


CONCLUSIONS
Medication management with a closed formulary in a diverse uninsured population reduced expenditures, with the largest savings coming from using prescriptions more efficiently while also providing a similar level of medical care.
Dvoracek
Jaclyn J
JJ
College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA.
Cook
Kristen M
KM
Klepser
Donald G
DG
D000554:Ambulatory Care Facilities / Q000191:economics / Q000458:organization & administration*; D015331:Cohort Studies; D017723:Drug Utilization Review; D005194:Family Practice / Q000191:economics / Q000458:organization & administration*; D005252:Fees, Pharmaceutical; D006801:Humans; D054539:Medication Therapy Management / Q000191:economics / Q000458:organization & administration*; D011203:Poverty / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013339:Students, Pharmacy