December 09, 2016
Magaly Rodriguez de Bittner, PharmD, BCPS, CDE, FAPhA, has dedicated her career to studying the impact pharmacists have on improving patient outcomes and decreasing unnecessary health care costs. Pharmacists are the most underutilized providers in health care, according to Dr. Rodriguez de Bittner, who said it’s critically important that they demonstrate a positive impact on delivering cost-effective care. She recently took time to discuss the findings of her new study that assessed how well 50 pharmacists provided chronic disease management to more than 600 patients with diabetes. Perhaps it’s no surprise that they excelled at medication management and driving down health care costs.
What were the study's main findings and big-picture benefits?
We found that patients who were cared for by pharmacists in between physician visits experienced a 50% drop in blood glucose levels and associated employer healthcare costs decreased by $1,000 per patient, mostly because patients required fewer emergency room visits and hospitalizations. In the study, pharmacists were able to better the lives of patients by improving clinical outcomes and reduce overall healthcare costs, even when the expense of therapy went up as patients became more adherent to their diabetes medications.
Why are diabetic patients challenging to manage?
The often have other associated comorbidities that require the use of multiple medications — diabetic patients take an average of 10 different drugs — so their care regimens can get very complex. It’s important that they adhere to their diabetes medications to keep blood glucose levels under control and to prevent complications such as blindness, kidney failure, heart disease, and neuropathy. They also need to self-manage meal planning, blood glucose monitoring, and exercise. Those tasks can be overwhelming.
What roles can health-system pharmacists play in improving the care of these patients?
Pharmacists are medication experts who are an essential part of the patient care team. They work in collaboration with the other health care providers to provide patients with medication management services, self-management education, and coaching. They’re uniquely positioned to collaborate with prescribing physicians to select the most effective medications for individual patients based on their characteristics and preferences, and to monitor treatments for effectiveness and the prevention of adverse reactions. Pharmacists have demonstrated in many clinical studies that they can effectively run medication management clinics to optimize the care of patients with chronic diseases such as diabetes.
Can you provide practical advice based on your research or real-world experience that pharmacists could use to improve these interactions?
It’s important that pharmacists recognize their unique role in the management of patients with chronic diseases. They must take full responsibility for patients’ clinical outcomes as a result of their medication treatments. It’s critical that they assess each patient’s preferences, cultural beliefs, and lifestyle in order to recommend optimal therapies. Patients must know that pharmacists are their partners in health and that they’ll make the best treatment decisions for them.
How many states designate pharmacists as “healthcare providers” and why is that label important?
It’s critical that state laws, health care plans, and the Social Security Act recognize pharmacists as health care providers as they continue to incorporate their experience and expertise into patient care. Approximately 38 states currently have some type of legislation or provision to recognize pharmacists as health care providers. Additionally, all but 2 states allow collaborative practice agreements that effectively allow pharmacists to adjust medication doses, change medication classes, order laboratory tests, and discontinue or start therapies. Excluding pharmacists from the Social Security Act prevents many state and private health care plans from compensating them for patient care services, such as medication coordination, medication therapy management, chronic disease management, and patient education. With the shortage of physicians across the United States, it’s becoming increasingly important to utilize the expertise and skill of all members of the patient care team, including pharmacists.
Rodriguez D Bittner M, Chirikov VV, Breunig IM, Zaghsb RW, Shaya FT. Clinical effectiveness and cost savings in diabetes care, supported by pharmacist counseling [Published online ahead of print October 18, 2016]. J Am Pharm ASSOC. doi: 10.1016/j.japh.2016.08.010.