Impact of Pharmacist-physician Collaborative Care Model on Patient Outcomes and Health Services Utilization

Kendra Babcock, Pharm.D., CentraCare Paynesville Hospital and Clinic

Background: Pharmacists make interventions, in both hospital and clinical settings, to improve outcomes for patients with both acute and chronic disease states.Six rural hospitals from the Carilion Clinic health system in southwest Virginia participated in a project to look deeper into this concept. The primary goal of the project was to assess the impact of a pharmacist-physician collaborative care model on patient outcomes and health services utilization. 

Methods: The majority of patients enrolled in the study were identified while hospitalized. Patients were considered eligible if they had a documented diagnosis of two or more of the seven core chronic conditions (congestive heart failure, hypertension, hyperlipidemia, diabetes mellitus, asthma, chronic obstructive pulmonary disease, and depression), prescriptions for four or more medications, and a primary care physician in the Carilion Clinic health system. The usual care group, or control group, was retrospectively identified by applying an EMR algorithm to patients in a health-system without an embedded clinical pharmacist. Resulting patients were not screened for additional pharmacist contact outside of their primary health-system. Primary clinical outcomes were differences in absolute change in measures associated with diabetes mellitus, hypertension, and hyperlipidemia management from baseline to the end of the two-year study between collaborative care and usual care groups. Pharmacists called patients within 72 hours of any hospital discharge, then scheduled an in-office follow-up within 14 days. Patients were contacted quarterly by the pharmacist thereafter to address patient-specific problems or concerns.

Results: A statistically significant decrease in hemoglobin A1c (mean difference of -0.46%, P<0.001), systolic blood pressure (mean difference of -6.28 mm Hg, P<0.0001), and diastolic blood pressure (mean difference of -2.69 mm Hg, P=0.0071) was seen in the collaborative care group compared to the usual care group. Differences seen in LDL cholesterol and total cholesterol were not statistically significant between groups. Since improvements were significant in three of the five clinical measures for patients in the collaborative care model, study investigators deemed the primary outcome achieved. Cost savings was also analyzed, with the collaborative care program providing a return on investment calculated at 504%.

Conclusions: Inclusion of clinical pharmacists in this physician-pharmacist collaborative care-based model was associated with significant improvements in patients’ medication-related clinical health outcomes.

Reference:

1. Matzke G, Moczygemba L, Williams K, Czar M, Lee W. Impact of a pharmacist-physician collaborative care model on patient outcomes and health services utilization. AJHP. 2018; 75(14): 1039-1047. Doi: 10.2146/ajhp170789.