Carter Barry L, Chrischilles Elizabeth A, Scholz David, Hayase Nobumasa, Bell Nancy
J Am Pharm Assoc (Wash). 2003 Jan;43(1):24-33. doi: 10.1331/10865800360467015.
OBJECTIVE To summarize the start-up experience with patients identified as eligible during the first four quarters of the Iowa Pharmaceutical Case Management (PCM) program and to characterize the extent of the services proved by pharmacists in the program. DESIGN Prospective pharmaceutical care intervention project. SETTING One hundred seventeen community pharmacies in Iowa. PATIENTS Medicaid patients at high risk for drug-related problems based on using 4 or more nontopical medications and having 1 of 12 specific disease states. INTERVENTION To become eligible to provide PCM services, licensed pharmacists had to undergo training and submit five care plans to the Iowa Department of Human Services. Community pharmacists were provided names of newly eligible patients each calendar quarter for 1 year. For each patient, pharmacists were asked to indicate by fax whether they had met with the patient, performed a written work-up of the patient, sent recommendations to the patient's physician, and whether the physician replied. When pharmacists were unable to provide the service, they were asked to state the reason. Both the pharmacist and the physician receive $75 for the initial assessment, with additional payments after each follow-up visit performed. MAIN OUTCOME MEASURES An intensity score and the percentage of eligible patients for whom all steps were completed were calculated for each pharmacy. RESULTS Fax survey results were returned for 2,834 (96.7%) of the 2,931 patients eligible for PCM services. Pharmacists met with 943 (33.3%), worked up 763 (26.9%), sent recommendations to physicians for 500 (17.6%), and received replies from physicians for 327 (11.5%) patients. Pharmacists were unable to provide PCM services for 1,891 (66.7%) patients. The primary reasons given for this inability to provide services were patient access issues for 438(23.2%) patients, pharmacy staffing or start-up issues for 419(22.2%) patients, or no reason specified for 575(30.4%) patients. A PCM intensity score was developed to represent the scope of services provided and the number of patients served. A higher intensity score indicated pharmacies that provided PCM to more patients and/or that offered higher levels of care (e.g., provided a written set of recommendations to the physician rather than simply assessing the patient without preparing or sending recommendations). Future evaluations will determine the validity of the score on the basis of patient outcomes. CONCLUSION Some pharmacies implemented PCM services very effectively. However, 40% to 60% of the pharmacies provided little or no PCM services within 3 months of notification of patient eligibility. Future investigations will evaluate the quality of prescribing and quality of life for patients who received PCM services.
目的 总结爱荷华州药物病例管理（PCM）项目前四个季度中被确定为符合条件的患者的启动经验，并描述该项目中药剂师提供服务的范围。设计 前瞻性药物治疗干预项目。地点 爱荷华州的117家社区药房。患者 基于使用4种或更多非局部用药且患有12种特定疾病状态之一的与药物相关问题高风险医疗补助患者。干预措施 为了有资格提供PCM服务，持牌药剂师必须接受培训并向爱荷华州公共服务部提交5份护理计划。在1年的时间里，每个日历季度都会向社区药剂师提供新符合条件患者的名单。对于每位患者，要求药剂师通过传真表明他们是否与患者会面、对患者进行了书面检查、向患者的医生发送了建议以及医生是否回复。当药剂师无法提供服务时，要求他们说明原因。初始评估时药剂师和医生均获得75美元，每次随访后还有额外报酬。主要观察指标 计算每个药房的强度得分以及所有步骤均完成的符合条件患者的百分比。结果 2931名符合PCM服务条件的患者中有2834名（96.7%）返回了传真调查结果。药剂师与943名（33.3%）患者会面、对763名（26.9%）患者进行了检查、向医生发送了建议的有500名（17.6%）患者，收到医生回复的有327名（11.5%）患者。药剂师无法为1891名（66.7%）患者提供PCM服务。无法提供服务的主要原因是438名（23.2%）患者存在患者准入问题、419名（22.2%）患者存在药房人员配备或启动问题，或575名（30.4%）患者未说明原因。制定了一个PCM强度得分来代表提供的服务范围和服务的患者数量。强度得分越高表明药房为更多患者提供了PCM服务和/或提供了更高水平的护理（例如，向医生提供了一套书面建议，而不是简单地在不准备或发送建议的情况下评估患者）。未来的评估将根据患者结果确定该得分的有效性。结论 一些药房非常有效地实施了PCM服务。然而，40%至60%的药房在收到患者符合条件通知后的3个月内几乎没有提供或没有提供PCM服务。未来的调查将评估接受PCM服务患者的处方质量和生活质量。
