ABSTRACT
BACKGROUND: The Medication Management Program was established at the Fraser Health Authority in 2005, in response to evidence suggesting that having pharmacists provide care to patients in their homes after discharge from hospital could reduce subsequent utilization of health service resources. OBJECTIVE: To determine the effectiveness of the Medication Management Program in its first 2 years of operation. METHODS: For patients who had received a home visit by a pharmacist, the utilization of health services (admissions to hospital, physician office visits, and dispensed medications) in the year before the home visit was compared with utilization during the year after the intervention. The net cost of the program was also determined. RESULTS: In the first 2 years of the Medication Management Program (2005/2006 and 2006/2007), a total of 1171 patients received a home visit from a pharmacist. Of these, 836 (71%) were included in the before-and-after analysis. The median per-patient cost for utilization of health services was $11 014 lower in the year after the intervention than in the year preceding the intervention. After the costs of the program were taken into account, this resulted in a net median cost reduction of $3047.43 per patient. CONCLUSION: The Medication Management Program was effective as a clinical program in its first 2 years.
ABSTRACT
Randomized pragmatic trials of drugs, physician education and drug policies are needed to improve pharmacosurveillance and cost-effectiveness of prescribing. Since 1994, we have developed and tested methods for low-cost education and policy trials to improve prescribing in primary care in Canada. We review methodology for using drug claims and other health services data to evaluate prescribing improvement programs and policies. We apply the lessons to a proposed trial of physician education tools (PET) for quality improvement of prescribing. Design issues for the trial include defining the potential programme in causal terms using counterfactuals, narrowing the denominator to the population affected, excluding noise from the numerator, calculating the prescribing preference, adjusting for baseline differences, controlling for modifiers and confounders, accounting for uncertainty when measuring impacts, and grouping practices for feedback and recognition. Data from a randomized trial of academic detailing illustrate measurement challenges. A decade of progress on methods for evaluating prescribing improvement programs with drug claims data has enabled planning of routine randomized pragmatic trials of education and policies in primary care in Canada.
