Provision of annual wellness visits with comprehensive medication management by a clinical pharmacist practitioner.
The effectiveness and financial benefit of pharmacist-led annual wellness visits (AWVs) in conjunction with comprehensive medication management (CMM) for older, high-risk patients were examined.



Eligible patients were 65 years of age or older with three or more chronic medical conditions, taking five or more long-term prescription or nonprescription medications and receiving primary care in a retirement community clinic. The intervention involved two components, an AWV and CMM. The AWV included all Medicare-required components. All participants saw a clinical pharmacist practitioner for an AWV with CMM and additional CMM visits at three and six months. Outcomes included completion of required AWV components, prevalence of medication-related problems (MRPs), classic return on investment, patient satisfaction, and change in rate of hospitalization.



Of the 60 eligible patients contacted, 53 (88%) agreed to participate. Patients' mean ± S.D. age was 82.1 ± 5.5 years, and patients used a median of 12 medications (range, 5-27) at baseline. The pharmacist identified at least 1 MRP in 90.6% of patients at the AWV; all patients had at least 1 MRP identified over six months. A total of 278 MRPs were identified: suboptimal drug (32.7%), insufficient therapeutic monitoring (25.2%), undertreatment of chronic condition (16.9%), and suboptimal dose, frequency, or administration (15.8%). Revenue generated by the pharmacist exceeded costs by 38.1%. The rate of hospitalizations did not significantly change after the intervention.



Pharmacists played a beneficial role in the provision of both AWVs and CMM, facilitating the completion of wellness visits and identifying and addressing MRPs in an older, high-risk population.
Mountain Area Health Education Center, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, Hendersonville Road, Asheville, NC tasha.woodall@mahec.net.
Tasha
T
Woodall
Mountain Area Health Education Center, University of North Carolina School of Medicine, Chapel Hill, NC.
Suzanne E
SE
Landis
Mountain Area Health Education Center, University of North Carolina School of Medicine, Chapel Hill, NC.
Shelley L
SL
Galvin
Mountain Area Health Education Center, University of North Carolina School of Medicine, Chapel Hill, NC.
Tim
T
Plaut
UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Mary T
MT
Roth McClurg
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008297:Male; D006278:Medicare / Q000592:standards / Q000639:trends; D059065:Medication Reconciliation / Q000379:methods* / Q000592:standards / Q000639:trends; D010593:Pharmaceutical Services / Q000592:standards / Q000639:trends; D010595:Pharmacists / Q000592:standards / Q000639:trends; D011314:Preventive Health Services / Q000379:methods* / Q000592:standards / Q000639:trends; D024382:Professional Role; D014481:United States / Q000453:epidemiology
delivery of health care; family practice/economics; health promotion; medication therapy management; pharmacists