Pharmacist-led medication management program within a patient-centered medical home.
OBJECTIVE
The impact of a clinical pharmacist-led medication management program (MMP) within a patient-centered medical home (PCMH) was evaluated.


METHODS
This retrospective analysis included patients in Sutter Health's electronic health records who (1) were seen by the MMP clinical pharmacist within the PCMH (MMP cohort), (2) were within the PCMH but were not referred to the MMP pharmacist (PCMH cohort), or (3) received usual care at two non-PCMH primary care clinics (usual care cohort). Patients were matched on their propensity for receiving medication management. The primary outcome measure was healthcare resource use (i.e., ambulatory care visits, emergency department [ED] visits, and hospitalizations).


RESULTS
MMP patients had a higher percentage of ambulatory care visits relative to PCMH patients (p = 0.004) but a lower rate of hospitalizations (p = 0.003). The MMP group had a lower frequency of hospitalizations (p < 0.001) and ED visits (p = 0.014) relative to patients in the usual care group. No differences in healthcare resource use were observed between the PCMH and usual care cohorts. Glycosylated hemoglobin, blood pressure, or low-density-lipoprotein cholesterol at goal did not significantly differ among the three cohorts.


CONCLUSIONS
Patients in a pharmacist-led MMP had a significantly higher estimated rate of ambulatory care visits but a lower rate of hospitalizations than did patients who attended the same clinic but were not in the MMP. MMP patients had a similar rate of ambulatory care visits but significantly lower rates of hospitalizations and ED visits than patients receiving usual care.
Robert J. Romanelli, Ph.D., M.P.H., is Health Services Researcher, Palo Alto Medical Foundation Research Institute, Palo Alto, CA, and Clinical Outcomes Research, Clinical Integration Department, Sutter Health, Sacramento, CA. Angela Leahy, Pharm.D., is Clinical Pharmacy Coordinator; Trevor Jukes, M.S., is Senior Data Analyst; and Denis Y. Ishisaka, Pharm.D., is Manager, Clinical Outcomes Research, Clinical Integration Department, Sutter Health.
Robert J
RJ
Romanelli
Robert J. Romanelli, Ph.D., M.P.H., is Health Services Researcher, Palo Alto Medical Foundation Research Institute, Palo Alto, CA, and Clinical Outcomes Research, Clinical Integration Department, Sutter Health, Sacramento, CA. Angela Leahy, Pharm.D., is Clinical Pharmacy Coordinator; Trevor Jukes, M.S., is Senior Data Analyst; and Denis Y. Ishisaka, Pharm.D., is Manager, Clinical Outcomes Research, Clinical Integration Department, Sutter Health.
Angela
A
Leahy
Robert J. Romanelli, Ph.D., M.P.H., is Health Services Researcher, Palo Alto Medical Foundation Research Institute, Palo Alto, CA, and Clinical Outcomes Research, Clinical Integration Department, Sutter Health, Sacramento, CA. Angela Leahy, Pharm.D., is Clinical Pharmacy Coordinator; Trevor Jukes, M.S., is Senior Data Analyst; and Denis Y. Ishisaka, Pharm.D., is Manager, Clinical Outcomes Research, Clinical Integration Department, Sutter Health.
Trevor
T
Jukes
Robert J. Romanelli, Ph.D., M.P.H., is Health Services Researcher, Palo Alto Medical Foundation Research Institute, Palo Alto, CA, and Clinical Outcomes Research, Clinical Integration Department, Sutter Health, Sacramento, CA. Angela Leahy, Pharm.D., is Clinical Pharmacy Coordinator; Trevor Jukes, M.S., is Senior Data Analyst; and Denis Y. Ishisaka, Pharm.D., is Manager, Clinical Outcomes Research, Clinical Integration Department, Sutter Health. Dyish0214@me.com.
Denis Y
DY
Ishisaka
D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000458:organization & administration; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D054539:Medication Therapy Management / Q000458:organization & administration; D008875:Middle Aged; D018802:Patient-Centered Care / Q000458:organization & administration*; D010593:Pharmaceutical Services / Q000458:organization & administration*; D010595:Pharmacists / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration; D012189:Retrospective Studies