# Presentation: 694412

## Innovative Pharmacy Services

- Jann B. Skelton, RPh, MBA
- Vice President of Operations
- MEDICA

## The BIG Picture....

## Project ImPACT: Hyperlipidemia

- National demonstration project of the APhA Foundation
- Deployed in 29 Pharmacies across 14 states
- Over 600 patients enrolled
- Sponsored through an unrestricted grant from Merck and Co.

**Notes:**
The results that I am going to share with you this afternoon represent data collected on patients who were enrolled in this project for an average of 14 months. Results looking at patients enrolled for an average of 24 months will be released during the APhA Annual Meeting in March of the Year 2000 in Washington, DC. 

## Project ImPACT: HyperlipidemiaRationale

- Hyperlipidemia is a modifiable risk factor in coronary heart disease
- Pharmacists services are widely accessible
- Evidence suggest that pharmacists can improve both compliance and outcomes
- A point-of-care testing device, the Cholestech LDX Analyzer is available to pharmacists with patient results available in 5 minutes
- The management of cholesterol disorders represents a major benchmark by which health care quality can be evaluated

## Current Detection and Treatment

- The majority of patients with lipid disorders are often not identified and not treated.
- On average, only...
- 35% of patients are diagnosed
- 32% of patients are prescribed a diet
- 12% of qualifying patients are prescribed a drug

- Adapted from Am J Cardiol  1998; 82:61-5

**Notes:**
Of the 35% of patients who are diagnosed only 32% are prescribed a diet and only 12% of the patient s qualifying for drug therapy receive a prescription 

## Financial Burden of CADestimated  in billions of dollars

## Patients Discontinuing Therapy

- n = 610

**Notes:**
At twelve months only 40% of patients prescribed lipid lowering drug therapy are still taking their medication.

This data is taken from research on 610 patients published in the Australian Journal of Medicine in 1996.

##   Adherence Comparison

- Existing Delivery System

**Project ImPACT Model**

- MJA  1996; 164:208,  JAPhA 1998; 38:529-34.

**Notes:**
There is a dramatic comparison between the results of Project ImPACT and the existing health care delivery system when you look at  the adherence of patients to lipid lowering medications .
 In fact the results are double that of other reported studies. The other studies we examined showed adherence rates ranging from  7% to 30%. The articles are referenced in the back of the Project ImPACT interim report which is available at the APhA Exhibit booth. 

## Medication Waste Costs for 1000 Patients in a Health Plan due to Noncompliance

- _Month_	_Pts Discontinuing Tx_	_Cost_
- 	1		200 x 1x $63		$12,600
- 	2		 50 x 2 x $63		$ 6,300
- 	3		150 x 3 x $63		$28350
- 	4		50 x 4 x $63			$12,600
- 	5		50 x 5 x $63			$15,750
- 	6		100 x 6 x $63		$37,800
- 	7		50 x 7 x $63			$22,050
- 	TOTAL COSTS				**$135,450**

## Examples of Innovative Pharmacy Services

- Osteoporosis
- Cardiovascular Disease
- Skin Damage
- Weight Management
- Glaucoma
- Diabetes

## Examples of Innovative Pharmacy Services

- Immunizations
- Asthma
- Smoking Cessation
- Hypertension
- Alzheimer’s
- Depression
- Urinary Incontinence

## How many have had these types of services provided by their pharmacist?

## The Pharmacist’s Role in Disease Prevention and Management

- Perform patient risk assessment and health screening
- Identify patients at risk
- Support compliance and adherence to prescribed medication and behavioral therapies
- Deliver patient education on disease prevention and disease management strategies

## The Pharmacist’s Role in Disease Prevention and Management

- Refer to physician for follow-up
- Physician provides diagnosis and prescribes therapy
- Pharmacist monitors drug therapy
- Provides ensures compliance and adherence
- Immediate interventions when problems are identified

## Identifying Individuals at Risk

- 80% of the population with osteoporosis is undiagnosed
- 50% of the 2 million Americans with glaucoma are unaware that they have the disease
- 33% of diabetics are unaware of their condition
- 65% of patients with high cholesterol are unaware until their first cardiac event

## The Importance of Professional Collaboration

- Less than 1% of physicians in the US are involved in preventive care programs
- Time constraints
- Financial incentives
- Pharmacists become a referral source for  physicians
- Improved cooperation and information flow improves patient care