Pay-for-performance remuneration for pharmacist prescribers' management of hypertension: A substudy of the RxACTION trial.
BACKGROUND
To be sustainable, pharmacists providing direct patient care must receive appropriate payment for these services. This prespecified substudy of the RxACTION trial (a randomized trial of pharmacist prescribing vs usual care in patients with above-target blood pressure [BP]) aimed to determine if BP reduction achieved differed between patients whose pharmacist was paid by pay-for-performance (P4P) vs fee-for-service (FFS).


METHODS
Within RxACTION, patients with elevated BP assigned to the pharmacist prescribing group were further randomized to P4P or FFS payment for the pharmacist. In FFS, pharmacists received $150 for the initial visit and $75 for follow-up visits. P4P included FFS payments plus incentives of $125 and $250 for each patient who reached 50% and 100% of the BP target, respectively. The primary outcome was difference in change in systolic BP between P4P and FFS groups.


RESULTS
A total of 89 patients were randomized to P4P and 92 to the FFS group. Patients' average (SD) age was 63.0 (13.2) years, 49% were male and 76% were on antihypertensive drug therapy at baseline, taking a median of 2 (interquartile range = 1) medications. Mean systolic BP reductions in the P4P and FFS groups were 19.7 (SD = 18.4) vs 17.0 (SD = 16.4) mmHg, respectively (p= 0.47 for the comparison of deltas andp= 0.29 after multivariate adjustment).


CONCLUSIONS
This trial of pharmacist prescribing found substantial reductions in systolic BP among poorly controlled hypertensive individuals but with no appreciable difference when pharmacists were paid by P4P vs FFS.
School of Pharmacy (Houle, Tsuyuki), University of Waterloo, Kitchener, Ontario; the Faculty of Pharmacy and Pharmaceutical Sciences (Charrois), the EPICORE Centre/COMPRIS (Charrois, McAlister, Kolber, Tsuyuki), the Department of Medicine (McAlister, Lewanczuk, Tsuyuki) and the Department of Family Medicine (Kolber), University of Alberta, Edmonton; the Cumming School of Medicine (Campbell), University of Calgary, Calgary, Alberta; and the School of Pharmacy (Rosenthal), University of Mississippi, Oxford, Mississippi, USA.
Sherilyn K D
SK
Houle
School of Pharmacy (Houle, Tsuyuki), University of Waterloo, Kitchener, Ontario; the Faculty of Pharmacy and Pharmaceutical Sciences (Charrois), the EPICORE Centre/COMPRIS (Charrois, McAlister, Kolber, Tsuyuki), the Department of Medicine (McAlister, Lewanczuk, Tsuyuki) and the Department of Family Medicine (Kolber), University of Alberta, Edmonton; the Cumming School of Medicine (Campbell), University of Calgary, Calgary, Alberta; and the School of Pharmacy (Rosenthal), University of Mississippi, Oxford, Mississippi, USA.
Theresa L
TL
Charrois
School of Pharmacy (Houle, Tsuyuki), University of Waterloo, Kitchener, Ontario; the Faculty of Pharmacy and Pharmaceutical Sciences (Charrois), the EPICORE Centre/COMPRIS (Charrois, McAlister, Kolber, Tsuyuki), the Department of Medicine (McAlister, Lewanczuk, Tsuyuki) and the Department of Family Medicine (Kolber), University of Alberta, Edmonton; the Cumming School of Medicine (Campbell), University of Calgary, Calgary, Alberta; and the School of Pharmacy (Rosenthal), University of Mississippi, Oxford, Mississippi, USA.
Finlay A
FA
McAlister
School of Pharmacy (Houle, Tsuyuki), University of Waterloo, Kitchener, Ontario; the Faculty of Pharmacy and Pharmaceutical Sciences (Charrois), the EPICORE Centre/COMPRIS (Charrois, McAlister, Kolber, Tsuyuki), the Department of Medicine (McAlister, Lewanczuk, Tsuyuki) and the Department of Family Medicine (Kolber), University of Alberta, Edmonton; the Cumming School of Medicine (Campbell), University of Calgary, Calgary, Alberta; and the School of Pharmacy (Rosenthal), University of Mississippi, Oxford, Mississippi, USA.
Michael R
MR
Kolber
School of Pharmacy (Houle, Tsuyuki), University of Waterloo, Kitchener, Ontario; the Faculty of Pharmacy and Pharmaceutical Sciences (Charrois), the EPICORE Centre/COMPRIS (Charrois, McAlister, Kolber, Tsuyuki), the Department of Medicine (McAlister, Lewanczuk, Tsuyuki) and the Department of Family Medicine (Kolber), University of Alberta, Edmonton; the Cumming School of Medicine (Campbell), University of Calgary, Calgary, Alberta; and the School of Pharmacy (Rosenthal), University of Mississippi, Oxford, Mississippi, USA.
Meagen M
MM
Rosenthal
School of Pharmacy (Houle, Tsuyuki), University of Waterloo, Kitchener, Ontario; the Faculty of Pharmacy and Pharmaceutical Sciences (Charrois), the EPICORE Centre/COMPRIS (Charrois, McAlister, Kolber, Tsuyuki), the Department of Medicine (McAlister, Lewanczuk, Tsuyuki) and the Department of Family Medicine (Kolber), University of Alberta, Edmonton; the Cumming School of Medicine (Campbell), University of Calgary, Calgary, Alberta; and the School of Pharmacy (Rosenthal), University of Mississippi, Oxford, Mississippi, USA.
Richard
R
Lewanczuk
School of Pharmacy (Houle, Tsuyuki), University of Waterloo, Kitchener, Ontario; the Faculty of Pharmacy and Pharmaceutical Sciences (Charrois), the EPICORE Centre/COMPRIS (Charrois, McAlister, Kolber, Tsuyuki), the Department of Medicine (McAlister, Lewanczuk, Tsuyuki) and the Department of Family Medicine (Kolber), University of Alberta, Edmonton; the Cumming School of Medicine (Campbell), University of Calgary, Calgary, Alberta; and the School of Pharmacy (Rosenthal), University of Mississippi, Oxford, Mississippi, USA.
Norman R C
NR
Campbell
School of Pharmacy (Houle, Tsuyuki), University of Waterloo, Kitchener, Ontario; the Faculty of Pharmacy and Pharmaceutical Sciences (Charrois), the EPICORE Centre/COMPRIS (Charrois, McAlister, Kolber, Tsuyuki), the Department of Medicine (McAlister, Lewanczuk, Tsuyuki) and the Department of Family Medicine (Kolber), University of Alberta, Edmonton; the Cumming School of Medicine (Campbell), University of Calgary, Calgary, Alberta; and the School of Pharmacy (Rosenthal), University of Mississippi, Oxford, Mississippi, USA.
Ross T
RT
Tsuyuki