RESEARCH
The Asheville Project: Clinical and economic outcomes of a community-based long-term medication therapy management program for hypertension and dyslipidemia

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Abstract

Objective

Assess clinical and economic outcomes of a community-based, long-term medication therapy management (MTM) program for hypertension (HTN)/dyslipidemia.

Design

Quasi-experimental, longitudinal, pre-post study.

Setting

12 community and hospital pharmacy clinics in Asheville, N.C., over a 6-year period from 2000 through 2005.

Participants

Patients covered by two self-insured health plans; educators at Mission Hospitals; 18 certificate-trained pharmacists.

Interventions

Cardiovascular or cerebrovascular (collectively abbreviated as CV) risk reduction education; regular, long-term follow-up by pharmacists (reimbursed by health plans) using scheduled consultations, monitoring, and recommendations to physicians.

Main outcome measures

Clinical and economic parameters.

Results

Sufficient data were available for 620 patients in the financial cohort and 565 patients in clinical cohort. Several indicators of cardiovascular health improved over the course of the study: mean systolic blood pressure, from 137.3 to 126.3 mm Hg; mean diastolic blood pressure, from 82.6 to 77.8 mm Hg; percentage of patients at blood pressure goal, from 40.2% to 67.4%; mean low-density lipoprotein (LDL) cholesterol, from 127.2 to 108.3 mg/dL; percentage of patients at LDL cholesterol goal, from 49.9% to 74.6%; mean total cholesterol, from 211.4 to 184.3 mg/dL; and mean serum triglycerides, from 192.8 to 154.4 mg/dL. Mean high-density lipoprotein (HDL) cholesterol decreased from 48 to 46.6 mg/dL. The CV event rate during the historical period, 77 per 1,000 person-years, declined by almost one-half (38 per 1,000 person-years) during the study period. Mean cost per CV event in the study period was $9,931, compared with $14,343 during the historical period. During the study period, CV medication use increased nearly threefold, but CV-related medical costs decreased by 46.5%. CV-related medical costs decreased from 30.6% of total health care costs to 19%. A 53% decrease in risk of a CV event and greater than 50% decrease in risk of a CV-related emergency department (ED)/hospital visit were also observed.

Conclusion

Patients with HTN and/or dyslipidemia receiving education and long-term MTM services achieved significant clinical improvements that were sustained for as long as 6 years, a significant increase in the use of CV medications, and a decrease in CV events and related medical costs.

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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