tients. During this period, the rate of therapeutic goals achieved increased from 74 percent at the time of patients’ initial pharmaceutical care encounters to 89 percent at patients’ latest encounters (Isetts et al., 2003).

Another collaborative model involving primary care physicians and clinical pharmacists was tested in a group of 197 hypertensive patients (Borenstein et al., 2003). Patients were randomized to an intervention group (physician–pharmacist comanagement) and a control group (physician-only care). Better blood pressure control was achieved in the comanagement group (60 percent) than in the control group (43 percent) (p = 0.02). Furthermore, the investigators found that the average provider visit costs/ patient were higher in the usual-care group ($195) than in the comanagement group ($160) (p = 0.02).

In a population-based cohort study between 1996 and 1997, 19,368 physicians were made aware of 24,266 (56 percent) medication alerts via a computerized drug utilization database linked to a telepharmacy intervention that triggered phone calls to physicians by pharmacists. The result was the change of 2,860 (24 percent) medications to a more appropriate therapeutic agent (Monane et al., 1998).

Successful collaborations between pharmacists and physicians can also be achieved with bidirectional communication, collaborative care of mutual patients, identification of a “win–win” opportunity, attention to physician convenience, and balanced dependence between the pharmacist and the physician (Brock and Doucette, 2004).

Medication Monitoring

Retrospective drug utilization reviews have been promoted as a useful tool for detecting and reducing medication errors (Lyles et al., 1998). However, a recent longitudinal ecologic and cohort study of six Medicaid programs that used the same review software in the mid-1990s did not find a reduction in the rate of exceptions to established medication-use criteria or any reduction in the incidence of hospitalization (Hennessy et al., 2003).

In a 5-month prospective observational study carried out in 2001, 215 drug reviews were conducted with 63 patients being treated at an outpatient hemodialysis center. The reviews found 113 drug discrepancies. Electronic drug records were discrepant by one drug record for 60 percent of patients, two drug records for 26 percent of patients, and more than two drug records for 14 percent of patients. Fifty percent of the 113 drug discrepancies put patients at risk for ADEs (Manley et al., 2003).



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement