Devine Emily Beth, Hoang Susan, Fisk Albert W, Wilson-Norton Jennifer L, Lawless Nathan M, Louie Clifton
Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA 98195-7630, USA.
J Am Pharm Assoc (2003). 2009 Mar-Apr;49(2):181-91. doi: 10.1331/JAPhA.2009.08009.
To (1) describe the role of clinical pharmacists in providing population-based pharmaceutical care as employees of a physician group practice, (2) describe the strategies used by pharmacists to optimize medication use, (3) quantify improvements in care, and (4) illustrate the calculations used to quantify cost savings.
Community-based, multispecialty, physician group practice located in the north Puget Sound area between 2003 and 2007.
Using four cornerstones (evidence-based medicine, therapeutic interchange, academic detailing, and a local pharmacy and therapeutics committee), the pharmacists provided population-based pharmaceutical care, leading generic switches, target drug programs, and prescription to over-the-counter medication switches. They also led disease management programs, managed drug recalls, implemented electronic health records, negotiated budgets with health plans, and led patient assistance programs and prior authorization programs to improve patient satisfaction.
Implementing these strategies from the vantage point of a physician group presents a seldom-realized employment opportunity for pharmacists.
The impact of these strategies is measured by process, use, and clinical outcomes metrics. These, in turn, are linked to incentive payments in the pay-for-performance environment or to a lowered per member, per month cost in the capitated environment.
In 2006-2007, 71% of our hypertensive patients received generic agents compared with a network average for receiving generic agents of 43%, while the proportion of patients with controlled blood pressure increased from 45% to 60%. We saved $450,000 in inpatient costs for deep venous thrombosis.
Clinical pharmacists employed in a physician group practice can optimize medication use, improve care, and reduce costs.
（1）描述临床药师作为医师集团执业机构员工在提供基于人群的药学服务中的作用；（2）描述药师用于优化药物使用的策略；（3）量化护理改善情况；（4）说明用于量化成本节约的计算方法。
2003年至2007年期间位于普吉特海湾地区北部的社区多专科医师集团执业机构。
药师利用四个基石（循证医学、治疗性药物互换、学术推广以及当地药学与治疗学委员会）提供基于人群的药学服务，主导通用名药物替换、目标药物项目以及处方药转换为非处方药。他们还领导疾病管理项目、管理药品召回、实施电子健康记录、与健康计划协商预算，并领导患者援助项目和预先授权项目以提高患者满意度。
从医师集团的角度实施这些策略为药师提供了一个很少实现的就业机会。
这些策略的影响通过过程、使用和临床结局指标来衡量。反过来，这些指标与绩效付费环境中的激励支付或人头付费环境中降低的人均每月成本相关联。
在2006 - 2007年，我们71%的高血压患者使用了通用名药物，而接受通用名药物的网络平均比例为43%，同时血压得到控制的患者比例从45%增加到了60%。我们在深静脉血栓形成的住院费用上节省了45万美元。
受雇于医师集团执业机构的临床药师可以优化药物使用、改善护理并降低成本。
