Journal of the American Pharmacists Association
RESEARCHThe Asheville Project: Clinical and economic outcomes of a community-based long-term medication therapy management program for hypertension and dyslipidemia
Section snippets
Objective
The objective of this study was to assess the clinical and financial outcomes of a long-term, pharmacist-driven MTM program for patients with HTN and/or dyslipidemia who were employees, spouses, or covered dependents of two large employers with approximately 12,000 covered lives in their self-insured health plans.
Methods
Two employers who were already providing long-term MTM programs for patients with diabetes or asthma began offering a similar program for covered health plan members with HTN and/or dyslipidemia. The unique components of the program were self-care education provided by professional educators at Mission Hospital's Health Education Center, face-to-face patient consultation services by community and hospital pharmacists, and financial incentives consisting of significantly reduced medication
Results
Inclusion criteria were met by 620 patients for the financial analysis and 565 for the clinical analysis. Of the 565 patients in the clinical cohort (Table 1), 46 withdrew during the study period: 38 withdrew due to employment change, 4 were terminated by the program for noncompliance, and 4 dropped out because they no longer wanted to participate.
Of 906 program enrollees, 25 were excluded from analysis because they enrolled but never received any program interventions (no education or care
Discussion
Included in the March/April 2003 issue of the Journal of the American Pharmacists Association (JAPhA)1 were results of a 5-year study of the long-term outcomes of the Asheville Project's disease management program that provided patient education and MTM services for 194 patients with diabetes. In the March/April 2006 issue of this same journal the results of a 5-year study of the long-term outcomes of the Asheville program for 207 patients with asthma were published.2 Significant clinical,
Limitations
The longitudinal analysis of patients in this pre—post study is subject to the limitations that are typical of a nonrandomized, real-world study with no control group. Of particular concern with this type of study is the possibility of regression to the mean (i.e., the chance that patients would have improved without the program interventions because, on average, a bad year would be followed by better years). We addressed this by looking back historically for 3 years before enrollment to ensure
Conclusion
A community-based CV disease management program that provided CV risk reduction education and face-to-face counseling by specially trained community and hospital pharmacists resulted in significant improvements in clinical and financial outcomes. After participation in the program, patients were significantly less likely to have a CV-related ED visit or hospitalization, a CV-related event, or CV-related medical expenses. This simple community-based model uses resources available in many
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