Pharmacists Making House Calls: METHODS

The Fraser Health Authority is 1 of 6 health authorities in the province of British Columbia, serving the health care needs of about 1.5 million people. This health authority comprises 12 acute care hospitals, as well as Home Health services for the communities it serves. The Medication Management Program is provided through Home Health and was established in 4 health service delivery areas within the Fraser Health Authority.

The patients included in this evaluation were those who received the home pharmacy intervention in the first 2 fiscal years of the Medication Management Program’s existence: April 1, 2005, to March 31, 2007. The intervention consisted of a visit by a pharmacist to the patient’s home to assess his or her medication regimen for the purposes of identifying and resolving drug-related problems, as well as reconciling the medications the patient was taking at home with what was prescribed at the time of hospital discharge.

The following data were retrieved from program records to determine the pharmacist’s activities performed as part of the intervention: the number of patients visited, the total number of visits, the amount of time per visit, and the number of recommendations made to improve drug therapy, as well as the number of other services provided as part of the pharmacist’s consultation (provision of medication teaching, clearing of medicine cabinets, recommendation of compliance aids, requests for laboratory monitoring, and nonpharmacologic interventions, such as blood pressure and glucose monitoring, reporting of adverse drug reactions, or referral to another health care professional). Apcalis Oral Jelly

The following sources were consulted to obtain Ministry of Health administrative data: Discharge Abstract Database for information about hospital stays, Medical Services Plan for fee- for-service billings for physician office visits, and PharmaCare for information about medications dispensed.

Data about the costs of running the program during the 2005/2006 and 2006/2007 fiscal years were also collected. These costs related to salary and benefits, mileage, technology, and data management and analysis.

The main outcome was resource utilization by recipients of the intervention, calculated by the following conservative formula: resource utilization ($) = length of hospital stay in days (multiplied by $1000/day) + Medical Services Plan costs + PharmaCare costs.

The data were analyzed by comparing each patient’s resource utilization over the 1-year periods before and after the intervention, a method of analysis that was also used in the HRPIP. A subgroup analysis was also performed to investigate resource utilization among low resource users (those at the 30th percentile or lower on overall resource utilization) and high resource users (those at the 70th percentile or higher on overall resource utilization). Because resource utilization for the year before the intervention would include the hospital stay that precipitated the intervention, the cost of the index hospital stay was calculated and subtracted from the resource utilization for the “before” year.

Excluded from this before-and-after analysis were patients who died within a year of the intervention, since less than a full year’s worth of post-intervention data was available for those patients. Patients whose referral to the Medication Management Program pharmacist was not a result of a hospital stay were also excluded from the main analysis. An additional analysis was performed for these patients to determine whether the pattern of resource utilization for this group differed from the pattern for those whose receipt of the intervention resulted from a recent hospital stay.

After initial data analysis for the main outcome, it was decided to perform a post hoc analysis to determine if the pattern of resource utilization differed for patients with care episodes (e.g., hospital stays) costing $50 000 or more. It was thought that the reason for the high-cost episodes of care might have been one-time, high-cost procedures that would not be affected by the intervention and that might have artificially skewed the data.
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Statistical significance was tested with the Mann-Whitney test for nonparametric data.

A secondary outcome measure was the net cost of the Medication Management Program over the 2-year period. This calculation took into account the cost of the program for each year, which was calculated as a sum of the cost data. Also included in the calculation of net cost was the median differ­ence in resource utilization in the 1-year periods before and after the intervention. For the purpose of the net cost calcula­tion, the median per-patient difference was multiplied by the number of patients in the analysis to generate the total median difference. The net cost of the Medication Management Program for the 2-year period was calculated with the following formula: net cost of program = total cost of program – total median difference. To calculate the net cost per patient, the net cost of the Medication Management Program was divided by the number of patients included in the evaluation.
Ethics approval for this study was granted by the Fraser Health Research Ethics Board in December 2007.

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