Strategies to optimize medication use in the physician group practice: the role of the clinical pharmacist.

OBJECTIVES

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.

SETTING

Community-based, multispecialty, physician group practice located in the north Puget Sound area between 2003 and 2007.

PRACTICE DESCRIPTION

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.

PRACTICE INNOVATION

Implementing these strategies from the vantage point of a physician group presents a seldom-realized employment opportunity for pharmacists.

MAIN OUTCOME MEASURES

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.

RESULTS

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.

CONCLUSION

Clinical pharmacists employed in a physician group practice can optimize medication use, improve care, and reduce costs.