Innovative Pharmacy Services

1. Innovative Pharmacy Services Jann B. Skelton, RPh, MBA Vice President of Operations MEDICA

2. The BIG Picture….

3. Project ImPACT: Hyperlipidemia • National demonstration project of the APhA Foundation • Deployed in 29 Pharmacies across 14 states • Over 600 patients enrolled Sponsored through an unrestricted grant from Merck and Co.

4. Project ImPACT: HyperlipidemiaRationale • Hyperlipidemia is a modifiable risk factor in coronary heart disease • Pharmacists services are widely accessible • Evidence suggest that pharmacists can improve both compliance and outcomes • A point-of-care testing device, the Cholestech LDX Analyzer is available to pharmacists with patient results available in 5 minutes • The management of cholesterol disorders represents a major benchmark by which health care quality can be evaluated

5. Current Detection and Treatment • The majority of patients with lipid disorders are often not identified and not treated. • On average, only... • 35% of patients are diagnosed • 32% of patients are prescribed a diet • 12% of qualifying patients are prescribed a drug Adapted from Am J Cardiol 1998; 82:61-5

6. Financial Burden of CADestimated in billions of dollars

7. Patients Discontinuing Therapy n = 610 Simons, et al MJA 1996; 164:208

8. Adherence Comparison Project ImPACT Model Existing Delivery System MJA 1996; 164:208, JAPhA 1998; 38:529-34.

9. Medication Waste Costs for 1000 Patients in a Health Plan due to Noncompliance • MonthPts Discontinuing TxCost 1 200 x 1x $63 $12,600 2 50 x 2 x $63 $ 6,300 3 150 x 3 x $63 $28350 4 50 x 4 x $63 $12,600 5 50 x 5 x $63 $15,750 6 100 x 6 x $63 $37,800 7 50 x 7 x $63 $22,050 TOTAL COSTS $135,450

10. Examples of Innovative Pharmacy Services • Osteoporosis • Cardiovascular Disease • Skin Damage • Weight Management • Glaucoma • Diabetes

11. Examples of Innovative Pharmacy Services • Immunizations • Asthma • Smoking Cessation • Hypertension • Alzheimer’s • Depression • Urinary Incontinence

12. How many have had these types of services provided by their pharmacist?

13. The Pharmacist’s Role in Disease Prevention and Management • Perform patient risk assessment and health screening • Identify patients at risk • Support compliance and adherence to prescribed medication and behavioral therapies • Deliver patient education on disease prevention and disease management strategies

14. The Pharmacist’s Role in Disease Prevention and Management • Refer to physician for follow-up • Physician provides diagnosis and prescribes therapy • Pharmacist monitors drug therapy • Provides ensures compliance and adherence • Immediate interventions when problems are identified

15. Identifying Individuals at Risk • 80% of the population with osteoporosis is undiagnosed • 50% of the 2 million Americans with glaucoma are unaware that they have the disease • 33% of diabetics are unaware of their condition • 65% of patients with high cholesterol are unaware until their first cardiac event

16. The Importance of Professional Collaboration • Less than 1% of physicians in the US are involved in preventive care programs • Time constraints • Financial incentives • Pharmacists become a referral source for physicians • Improved cooperation and information flow improves patient care