The Kaiser Permanente/USC Patient Consultation Study: change in use and cost of health care services.

The impacts of three alternative models of pharmacist consultation on the use and cost of health care services were studied. Two studies were conducted concurrently in an HMO over two years. In one, 6000 patients were randomly assigned to one of three consultation models; in the other, the three models were implemented in six geographic regions of California (4600 patients). The models were (1) consultation about new or changed prescriptions as mandated by state law (state model), (2) consultation focused on selected high-risk ambulatory care patients (Kaiser Permanente [KP] model), and (3) a control model. The patients were surveyed three times about their health status and satisfaction, and computerized data on health care use and cost were collected. The effect of the consultation models on the use and cost of health care services was examined across five risk groups that were based on drug-use profiles. An additional 37,750 patients (10% of the patients residing in the areawide study sites) were included in a supplemental analysis of the use and cost of health care services. There was no indication in the random-assignment study that pharmacist consultations affected either drug costs or the cost of office visits. Similar results were found in the areawide study, with the exception that the KP model was associated with lower drug costs than the control model. In the 10% sample, the KP model appeared to be associated with lower office visit costs but higher drug costs. Both models were associated with a lower likelihood of a hospital admission and with lower total health care costs for some high-risk patients compared with the control model. Counseling patients about their medications may be unlikely to reduce medication costs or the cost of office visits but may reduce the likelihood of hospital admissions and the overall costs of health care services; a combination of counseling patients at high risk for drug-related problems and counseling all patients about any new or changed prescription should be considered.

Measuring the impact of patient counseling in the outpatient pharmacy setting: the research design of the Kaiser Permanente/USC patient consultation study.

This article describes the research method used to measure the impact of three alternative models of patient counseling in the outpatient pharmacy setting. The study was conducted in pharmacies operated by the Southern California region Kaiser Permanente Medical Care Program. Both random assignment and large-scale geographic area research designs were used. The presentation of the research design includes discussions of data collection and patient sampling methods; the measurement of patient outcomes, including measures of health care costs and utilization, patient functional status, and quality of life. Demographic data are presented for the study population, including an analysis of potential biased selection of patients electing to participate in random assignment. Data are also presented documenting potential selection bias across geographically determined treatment groups in the geographic area design arm. Finally, the article presents the analysis plan for the study and discusses study limitations.

Droperidol stability in intravenous admixtures.

The stability and compatibility of droperidol in small-volume i.v. admixtures was assessed. Droperidol was diluted to a nominal concentration of 1 mg/50 ml in 5% dextrose injection, 0.9% sodium chloride injection, and lactated Ringer's injection in type I glass bottles and polyvinyl chloride bags. Triplicate samples of each admixture were stored under continuous illumination at 27 +/- 2 degrees C. Specimens from each sample were tested by spectrophotometric assay at intervals during storage periods of up to 272 hours for admixtures containing 5% dextrose injection and 0.9% sodium chloride injection and up to 168 hours for admixtures containing lactated Ringer's injection. Between 48 and 168 hours of storage, a 7% increase was observed in droperidol concentration in 0.9% sodium chloride admixtures in polyvinyl chloride bags. A 24% decrease in droperidol concentration in lactated Ringer's admixtures in polyvinyl chloride bags between 24 and 168 hours was attributed to sorption of droperidol by the plastic container. In all admixtures except those containing lactated Ringer's injection in polyvinyl chloride bags, droperidol concentrations throughout the storage period were within 10% of initial concentrations. Droperidol is stable in the admixtures studied for 7 to 10 days in glass bottles. In polyvinyl chloride bags, concentrations in admixtures containing 5% dextrose injection and 0.9% sodium chloride injection are stable for seven days, but concentrations decrease significantly in lactated Ringer's admixtures.