快樂小藥師 Im pharmacist nichts glücklich

August 18, 2009 (Adelaide, Australia) — Collaboration between doctors and pharmacists can reduce medication-related problems and hospitalizations and improve health outcomes in patients with heart failure, Australian researchers report in a study published online before print August 18, 2009 in Circulation: Heart Failure [1].

A service wherein pharmacists visited heart-failure patients in their homes to review their medications and then reported the findings to the patients' doctors cut the rate of hospitalization for heart failure by 45% in its first year of operation, Dr Elizabeth E Roughead (University of South Australia, Adelaide) and colleagues write.

"Medication-related problems contribute to the problem of hospitalization for heart-failure patients, so educating these patients about drug use is important," Roughead told heartwire . "The home visit part of this program enables time for more thorough education. Clinicians should work with pharmacists to help their heart-failure patients."

A Synergistic Relationship

Dr Mauro Moscucci (University of Miami Miller School of Medicine, FL) agreed that the partnership between pharmacists and clinicians has important and positive implications for improving outcomes for heart-failure patients.

"It's the synergy that is impressive. Improved outcome is due not to pharmacists' visits alone but to the partnership between the two healthcare providers," Moscucci told heartwire .

Roughead and her colleagues sought to determine whether collaborative medication reviews, which have been shown to be successful in improving outcomes for patients with heart failure in randomized controlled trials, would also be successful in a "real-world" setting. Such reviews are nationally funded in Australia.

They retrospectively reviewed administrative claims data on veterans and war widows aged 65 years and older who were prescribed bisoprolol, carvedilol, or metoprolol succinate for heart failure and compared 273 patients who received general practitioner-pharmacist collaborative home medication review with 5444 controls who did not.

The average age of the patients in both groups was 81.6 years. The median number of comorbidities was eight in the group who received the collaborative reviews compared with seven in the group who did not (p<0.0001). The group who received medication reviews also had more prescriptions, more changes in medication prior to their home review, prescriptions from a greater number of healthcare providers, and more hospitalizations.

"We chose to study a veteran population because they are elderly and an appropriate target population for home medicines review services," Roughead explained.

Review Delayed Hospitalization for Heart Failure

The time to hospitalization for heart failure was significantly delayed in the group that received a home medicines review, the investigators found. After adjustment for a variety of confounding variables, only 5.5% of the patients in the review group were hospitalized within a year, compared with 12% of the control group (hazard ratio [HR] 0.55, 95% CI 0.39–0.77; p<0.0001).

Pharmacist Dr Amy Seybert (University of Pittsburgh Medical Center, PA) told heartwire that pharmacists are particularly well-suited for counseling patients. "Definitely. It's what we are trained to do. We explain to patients why they should take their medications and stress the importance of compliance. We tell them how the drugs work. I really think that if patients understand why they are taking something and for what purpose, they are much more apt to be compliant."

Her colleague, Dr Joon Sun Lee (University of Pittsburgh Medical Center), agrees.

"The Australian study confirms much that is known. As treatment regimens, especially medication regimens for heart-failure patients, become more and more complex, the potential for patients to get confused becomes greater. So measures that confirm medication regimens and also check up on patients are effective at decreasing readmissions," he said.

It Works Well Down Under, But Will It Work in the US?

More and more institutions in the US are using pharmacists to help educate patients, usually as part of hospital discharge programs. But Sun Lee questions whether a partnership between pharmacist and clinician as the Australians have would be feasible in the US.

"One of the vulnerabilities and inefficiencies of the US healthcare system is that the collaborative medication review part of healthcare is not rewarded financially. It is an extra cost without reimbursement, whether you are talking about the hospital incurring the cost or the doctor's office. Right now, this is one of the cracks that exist in the delivery care system," he said.