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Is There a Pharmacist in the House?

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Is There a Pharmacist in the House?

Aug 24, 2015

Most people don’t think of pharmacists as being involved with primary care at the clinic, but Dr. Carrie McAdam-Marx, associate professor of pharmacotherapy at the University of Utah, thinks that needs to change. She talks about her research showing that patients with type 2 diabetes who consulted with pharmacists in the primary care setting had lower overall medical costs than those who didn’t. She explains how a pharmacist helps patients and physicians, and why she thinks pharmacists will be seen in the clinical care setting more often in the future.

Episode Transcript

Interviewer: Is there a pharmacist in the house? Making the case for pharmacists in a primary care setting. Up next on The Scope.

Announcer: Examining the latest research and telling you about the latest breakthroughs. The science and Research Show is on The Scope.

Pharmacists & Primary Care

Interviewer: Most people don't think of pharmacists as being involved with primary care at the clinic, but Dr. Carrie McAdam-Marx thinks that needs to change. She's the Associate Professor of Pharmacotherapy at the University of Utah. So you make the case that having a pharmacist in the primary care setting is not only better for the patient, but it also makes economic sense. And you did some research looking at that. Can you talk about that a little bit?

The Study

Dr. McAdam-Marx: We took a group of patients that had been treated in a primary care clinic that had access to a clinical pharmacist and these pharmacists were specifically focusing on patients with diabetes, type II diabetes. Patients with diabetes are on a lot of medications and, unfortunately, the average patient with type II diabetes is not optimally controlled. So we had approximately 300 patients that had been followed by a clinical pharmacist in the primary care setting and we compared those to about 400 patients in clinics that didn't have access to a pharmacist at that time.

It's a service that's evolving in our University of Utah community clinic is at this point. We looked at how their diabetes is controlled, we looked at their diabetes control over time, being followed by the pharmacist, but we also looked at their cost, their total cost of care from the perspective of the University of Utah Health System.

And both our intervention patients, those who saw the pharmacist and our comparison patients, saw an increase in cost over time, which isn't necessarily unexpected. They're older patients, they have complex health conditions and their costs are naturally going to tend to go up. But what we saw was that the patients who were followed by the pharmacist had a much slower increase in cost than those who were not.

Study Length & Cost

Interviewer: So over time, how much time were you looking at?

Dr. McAdam-Marx: We followed these patients for a year.

Interviewer: And differences in cost, how much of a difference?

Dr. McAdam-Marx: So in the comparison patients, their cost went up over that year, they were higher in the year after our baseline period by about $1200 per year. And then the comparison patients were closer to $200 increase per year.

Interviewer: Oh, wow.

Dr. McAdam-Marx: So it was substantial. It's difficult, in a short period of time, in a chronic disease to show an improvement like this so we were really excited with the results.

Interviewer: So they just had fewer complications or what was the reflection? What was the lower cost due to?

Dr. McAdam-Marx: We looked at total cost, so all of their outpatient costs and inpatient cost, emergency visit costs. What we found is that these patients used more primary care services. They were going in and having follow-up visits with their primary care provider. So that area was going up, but we saw a substantial decrease in other areas. So fewer needs to go see specialists and slightly lower costs in terms of inpatient and emergency room costs.

Importance of a Pharmacist in Primary Care

Interviewer: So what happens if a pharmacist is not involved in decision-making at the primary care clinic? What's an example of what can go wrong or how they can make things go better?

Dr. McAdam-Marx: As patients being treated by primary care doctors become more and more complex, more chronic diseases, multiple chronic diseases, they're on a multitude of medications, oftentimes. Sometimes these medications can interact or counteract each other and having a pharmacist on the team who that's what they're trained to do, to optimize drug therapy, can play a huge role in that team-based care.

They provide input and guidance to the primary care providers on what are the most optimal drug therapies for a given patient and so, when a patient has the opportunity to meet with a pharmacist and have a pharmacist review their drug therapy, there are often times opportunities to change doses, add medications or remove medications with the goal of helping that patient achieve the treatment goals that they're after: better disease control, fewer side effects in a more efficient and a more effective manner than might happen otherwise.

Interviewer: So do you find that patients are open to this idea of working with a pharmacist as a primary healthcare provider? I mean, we're used to thinking of well, at least me, maybe it's my bias, I'm used to thinking of going to Walgreens and talking to the person behind the glass window and getting my medications that way. It's sort of a conceptual shift for people. Are they ready for that?

Dr. McAdam-Marx: It's my impression that they are. To clarify, I'm a researcher so I'm actually not the one delivering this care. But I have a team of very excellent clinical pharmacists and their response is yes, definitely. They appreciate that their primary care provider is busy and they have a limited amount of time. Often times, they will meet with the pharmacist before the physician comes into the room and they can have an extended conversation about their medications, what they're experiencing, how things are working. I think they recognize the pharmacists as the drug experts.

And keep in mind that many of these patients are older and they grew up in the day of independent pharmacy, they call the pharmacist "Doc," they had a very personal relationship with them. So for them to transition that personal relationship out of the pharmacy and into the clinic, it was probably less of a shift than what we might think otherwise.

Interviewer: Great. Is there anything else you want to make sure to add?

Dr. McAdam-Marx: I'm excited to see the evolution of clinical pharmacy in the primary care setting and the growth in the profession itself. Pharmacists are trained specifically on drug knowledge and having that opportunity to carry that knowledge into the primary care setting, where, quite honestly, a lot of our care is delivered is really going to be very beneficial for patients, to providers, to payers, to the healthcare system. So I think it is going to be a win-win-win for everyone that's involved.

Interviewer: Interesting, informative and all in the name of better health. This is The Scope Health Sciences Radio.