THE IMPACT OF A PHARMACOTHERAPY CONSULTATION ON THE COST AND OUTCOME OF MEDICAL THERAPY

Background. One important task for physicians is to optimize their pat ients' medication regimen. Involvement of clinical pharmacists who hav e specific training in drug regimen design has been associated with im proved patient outcomes for specific medical conditions, eg, hypertens ion and anticoagulation. This prospective, randomized trial investigat ed whether a single consultation by a clinical pharmacist with high-ri sk patients and their primary physicians would result in improved pres cribing outcomes. Methods. Patients at risk for medication-related pro blems were identified and randomized to receive a pharmacotherapy cons ultation (consult group) or usual medical care (control group). Outcom es, including the number of drugs, number of doses per day, cost of me dications, and patient reports of adverse effects, were recorded at ba seline and at 6 months following the intervention. Results. Fifty-six subjects were evaluable: 29 in the control group, and 27 in the consul t group. Six months after the consultation, the number of drugs, the n umber of doses, and the 6-month drug costs all decreased in the consul t group and increased in the control group; the net difference was 1.1 drugs (P=.004), 2.15 doses per day (P=.007), $586 per pear (P=.008). The side effects score improved by 1.8 points more in the consult grou p compared with the control group (P=NS). Similarly, the prescribing c onvenience score in the consult group improved by 1.4 points more than that of the control group (P=NS). Conclusions. This study demonstrate s several important benefits of integration of a clinical pharmacist i nto a primary care setting, including improvement in cost and simplifi cation of the medication regimen with no reduction in quality of care.