Group practice strategies to manage pharmaceutical cost in an HMO network.

OBJECTIVE: To evaluate the prevalence of various pharmaceutical cost management strategies used by group practices within a managed care network and their relationship to drug costs among enrollees. STRATEGIES STUDIED: Care management (gatekeeping, practice profiling, practice guidelines, case management), techniques for maintaining clinic medication records, and policies regulating physician interaction with pharmaceutical sales representatives (PSRs). STUDY DESIGN: Cross-sectional survey of primary care group practice organizations (n = 103) affiliated with Blue Cross Blue Shield of Minnesota in early 1996. METHODS: Multivariate linear regression analysis was performed on corresponding claims data for members continuously enrolled in these practices from January 1 to December 31, 1995 (n = 76,387), using the patient as the unit of analysis. RESULTS: Substantial variation in strategy prevalence was observed; this variation was thought to influence pharmaceutical costs. Seventy-six percent of practices had medication lists in outpatient medical records, 53% had policies limiting pharmaceutical detailing, and 44% had patients assigned to primary care gatekeepers; however, only 10% used outpatient nurse case managers. Use of outpatient nurse case managers (P < .010), primary care physician gatekeeping (P < .002), policies to control pharmaceutical detailing (P < .001), and medication lists and outpatient charts (P < .001) was found to be independently associated with lower pharmaceutical expenditures. Significant colinearity was found between group size and the strategies studied. CONCLUSIONS: Significantly lower pharmaceutical costs per member per year were observed in the groups reporting primary care gatekeeping, outpatient medication records, outpatient case managers, and policies regarding physician interactions with PSRs.

Cost avoidance, acceptance, and outcomes associated with a pharmacotherapy consult clinic in a Veterans Affairs Medical Center.

A pharmacist-directed pharmacotherapy consult clinic (PCC) was established in an interdisciplinary primary care medicine continuity clinic. The pharmacist initiated or modified patient care plans in collaboration with primary care physicians and maintained care plans for 336 (32.8%) of 1023 patients enrolled in the continuity clinic. Clinical outcomes were positive in 88.3% of patient visits, with 95.7% attendance at the PCC clinic and 95% physician acceptance of pharmacist recommendations. Average reductions of 2.4 prescriptions/patient and 6.9 doses/day were achieved. Actual and potential cost avoidance totaled $54,730.56, with actual and potential savings realized compared with dollars spent at a ratio of 5.8:1. The pharmacist provided value-added services and contributed to decreased costs associated with care.

In vitro drug interference with home blood-glucose-measurement systems.

The in vitro effects of ascorbic acid, acetaminophen, salicylic acid, and gentisic acid on home blood-glucose-measurement systems were studied. Whole blood in the normoglycemic range was spiked with quantities of each study drug at low, moderate, and high therapeutic concentrations. The glucose concentration of the blood was measured using Chemstrip bG, Dextrostix, and Visidex II home blood-glucose-monitoring systems. Serum samples were also measured by two automated systems, a glucose-oxidase method and a hexokinase method. Mean values were compared within the same glucose-measurement system to determine the extent of drug interference, and to values obtained by other systems to determine the reliability among systems. Changes between the control and treatment glucose mean concentrations of 20% or more were considered clinically important. Drug interference was observed with all three home blood-glucose-measurement systems and was drug-concentration dependent. Both automated systems were associated with drug interference at the highest concentration of salicylic acid, and the hexokinase method was influenced at the highest concentration of gentisic acid. No clinically important differences were observed between the automated systems; however, differences were observed between the automated and home blood-glucose-monitoring systems. Salicylic acid, acetaminophen, and ascorbic acid interfere with home blood-glucose-measurement systems. Switching between home blood-glucose-measurement systems could result in a poor assessment of blood-glucose values. In general, the values determined by home and automated systems should not be compared clinically.

Pharmaceutical services in hospital-based home health-care agencies--1982.

A survey of Medicare-certified hospital-based home health-care agencies was conducted in May 1982 to determine the type and extent of pharmaceutical services provided. A 12-page questionnaire was mailed to 243 directors of U.S. agencies that were identified from a 1976 directory. The questions elicited information about the characteristics of the director and agency, personnel, reimbursement, and scope of services. The overall response rate was 73.7%. Ninety-five percent of the agency directors were nurses. The median patient census of the agencies was 110. All agencies reported offering visiting-nurse services, 92% provided home health-aide services, and 46% offered home hospice services. Ninety-nine percent and 91% reported receiving reimbursement from Medicare and Medicaid, respectively. One fourth of the agencies provided home services that traditionally involve hospital pharmacists, including intravenous therapy (29%), home chemotherapy (18%), and total parenteral nutrition (18%). Although 85% of the agency directors reported using the services of a pharmacist, only 4% actually employed a pharmacist on their staff. The directors viewed educational programs, drug regimen review, and drug information services as the most important functions of pharmacists in home health-care agencies. Although these agencies provided an array of pharmaceutical services in 1982, very few pharmacists were actually employed. Additional studies are needed to re-evaluate the current status of pharmacy involvement in home health care.