Pharmacists Making House Calls: RESULTS part 2

home visit

Figure 1 illustrates the changes in median resource utilization for patients stratified according to their resource utilization before the intervention. As noted in Tables 1 and 2, overall costs declined after the intervention. This diagram illustrates that most of the patients had lower expenditures after the intervention; however, a small number did move to a higher expenditure category.

Figure 1. Changes in resource utilization
Figure 1. Changes in resource utilization after home visit from a pharmacist (interven­tion) following discharge from acute care. The groups with low and high resource utilization before the intervention represent the bottom and top 30% of expenditures (30th percentile and below and 70th percentile and above, respectively). The cut-offs were expenditures of $10 687 or less for the group with lowest resource utilization and expenditures of $25 694 or more for the group with the highest resource utilization. The same values were used to define low and high resource utilization after the intervention. Percentages may not sum to 100 because of rounding.

A separate analysis was performed to determine the median resource utilization among the 133 patients whose intervention was not the result of a hospital admission. In this group, median resource utilization increased after the pharmacist’s home visit relative to the year before the intervention (Table 3). viagra 50 mg

Table 3. Analysis of Results in Relation to Prior Admissions to Hospital

Median Utilization, $

Group

Before Intervention

After Intervention

Median Difference,* $

No prior admission

Women(n = 92)

Men(n = 41)


3 078
1 483


4 591
2 672

-1 513
p<0.001 -1 189
p<0.001

Prior admissions

Women
(n
= 503)

Men
(n
= 333)


17 408 15 425


5 579 5 708


11 829
p<0.001

9 717
p<0.001

A total of 110 patients had care episodes that cost $50 000 or more. When these patients were removed, and the median resource utilization of the remaining 726 patients was re­analyzed, the overall pattern of resource utilization before and after the intervention remained the same; however, the magnitude of differences was smaller (Table 4).

Table 4. Median 1-Year Resource Utilization Before and After Intervention, Excluding Patients with Care Episodes Costing $50 000 or More (n = 726)

Variable

Before Intervention

After Intervention*

Differencet (Before-After)


Median resource utilization


$14 657


$5 099


$9 558


p<0.001


Median length of hospital stay


10
days


0 days


10
days


Median no. of hospital admissions


1


0


1


Median cost of Medical Services Plan


$2 110


$1 706


$404


Median PharmaCare costs


$1 570


$2 118


-$548

The total cost of running the Medication Management Program during 2005/2006 and 2006/2007 was $808 050.14 (Table 5). During this 2-year period, 4 pharmacists worked with the program. The cost of salaries and benefits for the first year was slightly lower than the cost during the second year, because some of the pharmacists started after the beginning of the fiscal year (April 1). The net median difference for the study period was $4014 (median difference in resource utilization minus median cost of index hospital stay). Multiplied by 836, the number of patients in the analysis, this value yielded a total difference of $3 355 704. After the cost of running the program for 2 years was subtracted, there was a potential net benefit of $2 547 653.90. This translates into a potential median net benefit of $3047.43 per patient included in this analysis.  levitra plus

Table 5. Cost of Medication Management Plan

Fiscal Year; Cost, $

Item

2005/2006

2006/2007

Two-year Total


Salaries and benefits


341 696.35


412 772.15


754 468.50


Mileage*


9 589.35


7 492.29


17 081.64


Technology+


10 500.00


14 000.00


24 500.00


Data management*


6 000.00


6 000.00


12 000.00


Total


367 785.70


440
264.44


808 050.14

Category: Main

Tags: home visit, pharmacist, resource utilization

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