Interpreting the findings of the IMPROVE study

Various findings of the Impact of Managed Pharmaceutical Care on Resource U tilization and Outcomes in Veterans Affairs Medical Centers (IMPROVE) study are reviewed. Suggestions for future methodologies that will enhance this study are discussed. The IMPROVE study is one of the largest pharmaceutical care st though it wa s an intervention study that examined global outcomes following management by pharmacists, it was designed as an effectiveness study. Several new prac tice and research methods were developed, including a method to identify pa tients at high risk for drug-related problems utilizing pharmacy databases, a method to identify chronic diseases using pharmacy databases, a method t o evaluate the structure and process for delivering pharmaceutical care in Veterans Affairs medical centers (VAMCs), and guidelines for providing care to patients in the IMPROVE study. Nine VAMCs participated in the study, an d 1054 patients were randomized to either an intervention group (n = 523) o r a control group (n = 531). Pharmacists documented a total of 1855 contact s with the intervention group patients and made 3048 therapy-specific inter ventions over the 12-month study period. There was no meaningful difference in patient satisfaction or quality of life in the two groups. Selected dis ease-specific indicators found an improved rate of measurement of hemoglobi n A(1c) tests and better control of total and low-density-lipoprotein (LDL) cholesterol levels in the intervention group compared with the control gro up. Total health care costs increased in both groups over the 12-month peri od. The mean increase in costs in the intervention group was $1020. which w as lower than the control group's value of $1313. The lessons learned from the IMPROVE study suggest to future investigators how to study and measure the effects of clinical pharmacy services on patie nt outcome.