Pharmacists Involved in Direct Patient Care Improve Outcomes, University of Arizona Research Shows

New research from the University of Arizona confirms what clinical pharmacists have known for a long time: when a pharmacist is part of the medical care team, patients with diabetes, high blood pressure, high cholesterol and a host of other chronic diseases manage their conditions better. And when a pharmacist is included directly in care decisions, patients of all stripes experience fewer adverse effects from their medications.
TUCSON, Ariz. – More Americans than ever are taking prescription drugs to treat illness, for both acute and chronic conditions, but few of these consumers involve a pharmacist directly in their medical care (other than dispensing medications). And that’s probably keeping them from getting the most benefit from their medication therapy.
 
New research from the University of Arizona confirms what clinical pharmacists have known for a long time: when a pharmacist is part of the medical care team, patients with diabetes, high blood pressure, high cholesterol and a host of other chronic diseases manage their conditions better. And when a pharmacist is included directly in care decisions, patients of all stripes experience fewer adverse effects from their medications.
 
Marie A. Chisholm-Burns, PharmD, MPHMarie A. Chisholm-Burns, PharmD, MPH, professor at the UA College of Pharmacy, led a team that closely reviewed nearly 300 peer-reviewed journal articles that examined the effect of pharmacist-provided direct patient care. The results of the meta-analysis, published in the October 2010 issue of Medical Care, are clear, she says.
 
“We looked at studies involving a wide range of diseases, patients and health-care settings,” Dr. Chisholm-Burns says. “We found that whether the patients were children or geriatric patients, from all spectrums of practice settings – whether we were talking about services provided in community pharmacies, clinics, large academic health-care institutions to smaller rural hospitals – including pharmacists in direct patient care improved outcomes.”
 
Nearly 90 percent of the studies that were related to diabetes management showed pharmacists making a positive difference, Dr. Chisholm-Burns says. Pharmacist interventions or services improved patient outcomes in greater than 80 percent of the studies on managing blood pressure and those looking at high cholesterol treatment.
 
Equally important, Dr. Chisholm-Burns says, is that the UA team’s analysis shows that patients are 47 percent less likely to experience an adverse drug event when a pharmacist is included in direct patient care. Any injury caused by the use of a drug or by the discontinuation or dose change of a medication qualifies as an adverse drug event. 
 
“It’s no surprise that pharmacists – the professionals who devote their training to understanding the complexities of how and why drugs work and how to maximize therapeutic outcomes – can be instrumental in making sure patients are getting the right medicine in the right dose at the right time,” Dr. Chisholm-Burns says.
 
“Wouldn’t it be wonderful if we could eliminate nearly half of the incidence of people getting hurt by their medicines just by working more closely with pharmacists when drug therapies are prescribed?”
 
Today, it’s often up to the consumer to seek out the expertise of the pharmacist in direct patient care, Dr. Chisholm-Burns says.
 
“In many settings, the burden of getting a pharmacist involved in recommending therapies and monitoring their effectiveness may default to the patient,” she says. “The patient may have to ask directly whether a pharmacist is on the team. I advise patients in hospitals to demand to speak to a pharmacist about the medications they were taking when admitted, during their hospital stay and at the time of discharge. Patients should ask why each agent was selected compared to others available, the desired results of the medication and the time frame and the possible side effects.”
 
Dr. Chisholm-Burns says such discussions also are important outside the hospital. Nearly half of all Americans use at least one prescription drug a month, with many using more. Dr. Chisholm-Burns urges these consumers to take full advantage of the pharmaceutical expertise available to them when they obtain their medicines.
 
“Speak to the pharmacist, even if there’s a line at the counter,” she says. “Ask what the medicine is expected to do, if it interacts with foods, herbal supplements, over-the-counter products and any other prescriptions you have.
 
“I wish everyone would consult the pharmacist even when they buy aspirin, cough syrup and other over-the-counter medicines. After doing this meta-analysis, I believe more strongly than ever that the knowledge pharmacists have is critical to improving health.”
 
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Photo Cutline: Marie A. Chisholm-Burns
 
Video shorts of Dr. Chisholm-Burns
 
About Marie A. Chisholm-Burns
Marie A. Chisholm-Burns, PharmD, MPH, is a professor and head of the Department of Pharmacy Practice and Science at the University of Arizona College of Pharmacy. Before coming to Arizona, she was at the University of Georgia College of Pharmacy, where she was the first woman to rise through the ranks from assistant to associate to full professor in a tenure track.
The research meta-analysis that Dr. Chisholm-Burns headed was funded by the American Society of Health-System Pharmacists Foundation. Dr. Chisholm-Burns was also a participant in the society and foundation’s Pharmacy Practice Model Initiative, a November 2010 conference that brought together thought leaders throughout hospital and health-system pharmacy to reach consensus on optimal practice models based on the effective use of pharmacists as direct patient-care providers
In 1999, Dr. Chisholm-Burns established the Medication Access Program, which provides services to increase access to medications for solid-organ transplant recipients. Over the years, Dr. Chisholm-Burns has developed an expertise in pharmacy teaching methods and transplant medicine, and has published more than 130 peer-reviewed articles, books and book chapters. She is an editor of several books including the therapeutics textbook Pharmacotherapy: Principles & Practice and the author of How To Prepare for the PCAT Pharmacy College Admission Test, which is the standardized test used by most colleges of pharmacy in their pharmacy school student selection. She is a recipient of the Medical Book Award from the American Medical Writers Association.
Dr. Chisholm-Burns has received more than $8 million in external funding as principal investigator. She is a Fellow of the American Society of Health-System Pharmacists and the American College of Clinical Pharmacy. She has received numerous awards, including the American Association of Colleges of Pharmacy Innovations in Teaching Award, the American College of Clinical Pharmacy Education Award, the American College of Clinical Pharmacy Clinical Practice Award and the Regents’ Research in Education Award. In 2005, she received the Robert K. Chalmers Distinguished Pharmacy Educator Award from the American Association of Colleges of Pharmacy.
In 2006, the American Pharmacists Association awarded Dr. Chisholm-Burns the Daniel B. Smith Practice Excellence Award, the group’s highest award for pharmacy practice. She also was inducted into the National Academies of Practice in 2006 for her contributions to the advancement of professional pharmacy practice (a group with a limited membership of 150 health-care professionals). The American Association of Colleges of Pharmacy awarded Dr. Chisholm-Burns the Rufus A. Lyman Award for most outstanding publication in American Journal of Pharmaceutical Education in 1996 and 2007.