IMPLEMENTING DISEASE MANAGEMENT IN COMMUNITY PHARMACY PRACTICE

Disease management (DM) is a comprehensive approach to preventing and treating disease that: (I) targets patients with specific diseases; (2 ) provides integrated services across organizational and professional boundaries; (3) utilizes services based on the best scientific evidenc e available; and (4) focuses on outcomes. DM differs from pharmaceutic al care in that pharmaceutical care targets not only patients with spe cific diseases but also those with risk factors for drug-related probl ems, a history of nonadherence, and frequent changes in medication reg imens. Steps to starting a DM program include: (1) identifying a targe t population based on the population's strategic importance to the goa ls and aims of the organization; (2) assessing the organization's avai lable resources, both internal and external; (3) defining key indicato rs with which to assess the program for the purposes of internal quali ty control and of obtaining compensation from third-party payers; (4) implementing the program using the best scientific methods available; and (5) assessing the impact of the program. The development of a smok ing cessation program at a nationwide retail pharmacy chain is used as an example of a DM program initiated in community pharmacy practice. Pharmacists are well positioned to take a major role in DM, because th ey are accessible to the community and because DM frequently involves drug therapy. DM is also widely used in managed care. It is important that community pharmacists be closely involved in the DM approach as i t evolves.