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L is for Listening
Talking to patients, even if only by telephone, can make them happier, more likely to stick to their drug regimens and less likely to end up seeking follow-up care in emergency rooms or clinics, two different studies by UCSF pharmacists have found.
The studies demonstrate how a small amount of attention from pharmacists can clarify and comfort, saving the health care system both money and time.
That patients react more positively to their care if someone telephones them following an emergency room visit or a hospital stay may seem obvious. But the practice remains rare.
Moreover, until now, no one had studied the impact of pharmacist-based interventions, despite the fact that reductions in the length of hospital stays and the complexities surrounding postdischarge drug treatment plans have made the role of the pharmacist more important than ever.
The stress and confusion of the moment also complicate matters. Clinical pharmacists understand all too well that just because a drug treatment plan has been discussed with a patient does not mean it has been understood, just as filling a prescription does not ensure adherence.
In the first study, published in the December 2001 issue of the American Journal of Medicine, UCSF clinical pharmacist Vicky Dudas and her colleagues Steve Pantilat, Tom Bookwalter and Kathleen Kerr followed adult patients admitted to the general medicine service at UCSF who had received counseling from a pharmacist when leaving the hospital. Of the more than 200 patients who participated in the study, half received telephone calls two days after discharge.
Says Dudas and her co-investigators, "The content of the call followed a consistent script and included questions about how patients had been feeling since going home, their follow-up appointments, their understanding about how to take their medications, if they had any side effects, and other concerns."
One-quarter of the patients telephoned had questions about their medications, not the least of which was how to obtain all their prescribed drugs. In each case, Dudas explains, the pharmacy service intervened successfully to solve the problem.
Equally important, another 15 percent of patients reported new problems — problems that resulted in physician referrals. This could help explain why the contingent receiving postdischarge telephone calls was far less likely to make a return visit to the emergency room (10 percent) than those who did not receive a call (24 percent.) Not surprisingly, more of the former felt satisfied with their care (86 percent) than those who were not contacted (61 percent).
The savings of this low-tech intervention were also impressive: More than $110 per patient was saved.
A similar, if stronger, therapeutic "alliance" was the goal of UCSF clinical pharmacist Patrick Finley in his study of drug adherence among the depressed. "The management of these patients has become a major health policy concern," says Finley, who wanted to learn if outcomes — which generally improve if the patients take their antidepressant drugs as prescribed — were affected by placing clinical pharmacists at the junction of primary care and psychiatry.
This required that pharmacists coordinate follow-up treatment over a period of six months. Such treatment consisted of telephone calls, office visits and the authority to change drugs in consultation with the patient's primary care physician. Approximately 100 patients participated in the study, with a similar-size group serving as the control.
As reported in the American Journal of Health-System Pharmacy, the comparative impacts of this pilot study mirrored the importance of follow-up found in the general adult population study of Dudas and her colleagues.
For example, more of the depressed patients who were counseled by pharmacists completed a full six months of treatment (76 percent to 49 percent). Among those receiving guidance by pharmacists, patient satisfaction rates were also higher and return visits to primary care providers were fewer.
And although a comparative cost analysis was not part of the UCSF project, at least one other published study has reported an annual cost savings of nearly $1500 each among patients completing a full course of antidepressants. "We need to do a large randomized trial to measure definitive impact," says Finley.
But even at this preliminary stage, the value of the intervention in terms of compliance and medication management seems clear. Indeed, more than 20 sites around the country have already implemented the protocol.
by Jeff Miller