Prescriber acceptance rate of pharmacists' recommendations.

OBJECTIVES: To determine the prescriber acceptance rates of pharmacists' recommendations, specifically related to 2 Medicare Part D Star ratings: appropriate use of high-risk medications (HRMs) in elderly patients and use of statins for primary prevention in patients with diabetes. The secondary objective was to assess factors associated with prescriber acceptance. DESIGN: Retrospective cohort. SETTING AND PARTICIPANTS: Medicare Part D beneficiaries at a regional grocery store chain pharmacy in Michigan from January 2014 to October 2015. MAIN OUTCOME MEASURES: Prescriber acceptance rate of recommendations related to HRM use or treatment with a statin in patients with diabetes. RESULTS: Data were collected and analyzed for 200 patients, of which 100 were recommended to discontinue an HRM (HRM group) and 100 were recommended statin therapy owing to diabetes (statin group). Out of the 200 pharmacist-initiated recommendations, 100 were directed to a prescriber and therefore included in the calculation of prescriber acceptance. Overall, 35.0% of those recommendations were accepted, with individual group rates of 58.9% (23/39) and 19.7% (12/61) in the HRM group and statin group, respectively. Patients who were prescribed a statin for primary prevention of cardiovascular events were more likely to have concurrent dyslipidemia. CONCLUSION: The prescriber acceptance rates observed in this study were similar to those reported in published literature. The results of this study might suggest that prescribers and patients with diabetes may be reluctant to initiate statin therapy for primary prevention without a concurrent diagnosis of dyslipidemia. Although further research is required, strategies to optimize communication and augment patient education may be useful to increase prescriber as well as patient acceptance of recommendations made by community pharmacists.

Demonstration of community pharmacy and managed care organization collaboration on cardiovascular disease risk factor identification using health risk appraisal.

OBJECTIVE: To integrate the resources from a local statewide managed care organization (MCO) and a supermarket pharmacy chain to conduct a comprehensive health risk appraisal (HRA). Collected data were used to assess cardiovascular risk factors and identify disease management opportunities. METHODS: An analysis to determine the prevalence of risk factors was conducted on a cross-sectional HRA survey. The HRA involved point-of-care cholesterol screening (with a follow-up risk factor questionnaire) conducted by pharmacist employees of the employer group (a regional supermarket chain). Those eligible for the screening were employees of the supermarket chain and their dependents covered by the participating MCO. RESULTS: A total of 12,915 completed HRA questionnaires were received. The mean age of the employees participating was approximately 44 years. Of note, 14%, 24%, 21%, and 69% of questionnaires had abnormal values for total cholesterol, high-density lipoprotein (HDL) cholesterol, blood pressure, and body mass index (BMI), respectively. Compared with national benchmarks, low HDL cholesterol and BMI more than 30 kg/m2 were more common in this cohort. More than one-fourth of the employees in this analysis were identified as being at high risk for a coronary heart disease event. CONCLUSION: The unique collaboration presented here allowed for an expanded role of pharmacists to implement a quality improvement program. In response, the employer decided to continue the HRA screening and offer a employee contribution reduction-based health incentive to covered members. The employer also is considering offering cardiovascular disease management interventions that will be performed by the supermarket chain's pharmacists and targeted toward the identified risk factor trends.