RESEARCH
The Asheville Project: Long-Term Clinical, Humanistic, and Economic Outcomes of a Community-Based Medication Therapy Management Program for Asthma

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ABSTRACT

Objective

To assess clinical, humanistic, and economic outcomes of a community-based medication therapy management (MTM) program for 207 adult patients with asthma over 5 years.

Design

Quasi-experimental, longitudinal pre—post study.

Setting

12 pharmacy locations in Asheville, N.C.

Patients/Other Participants

Patients with asthma covered by two self-insured health plans; professional educator at Mission Hospitals; 18 certificate-trained community and hospital pharmacists.

Interventions

Education by a certified asthma educator; regular long-term follow-up by pharmacists (reimbursed for MTM by health plans) using scheduled consultations, monitoring, and recommendations to physicians.

Main Outcome Measures

Changes in forced expiratory volume in 1 second (FEV1), asthma severity, symptom frequency, the degree to which asthma affected people's lives, presence of an asthma action plan, asthma-related emergency department/hospital events, and changes in asthma-related costs over time.

Results

All objective and subjective measures of asthma control improved and were sustained for as long as 5 years. FEV1 and severity classification improved significantly. The proportion of patients with asthma action plans increased from 63% to 99%. Patients with emergency department visits decreased from 9.9% to 1.3%, and hospitalizations from 4.0% to 1.9%. Spending on asthma medications increased; however, asthma-related medical claims decreased and total asthma-related costs were significantly lower than the projections based on the study population's historical trends. Direct cost savings averaged $725/patient/year, and indirect cost savings were estimated to be $1,230/patient/year. Indirect costs due to missed/nonproductive workdays decreased from 10.8 days/year to 2.6 days/year. Patients were six times less likely to have an emergency department/hospitalization event after program interventions.

Conclusion

Patients with asthma who received education and long-term medication therapy management services achieved and maintained significant improvements and had significantly decreased overall asthma-related costs despite increased medication costs that resulted from increased use.

Section snippets

Objective

The objective of this study was to assess the clinical, humanistic, and economic outcomes of a pharmacist-driven medication therapy management (MTM) model for patients with asthma. These patients were employees, spouses, or covered dependents of two large employers that together have approximately 12,000 covered lives in their self-insured health plans.

Methods

Two employers who offered MTM services for employees with diabetes began offering a similar service to their employees with asthma. The unique components of the program were self-care education provided by a certified asthma educator at the Mission Hospitals' Health Education Center, MTM services by community and hospital pharmacists, and financial incentives consisting of waived medication copayments on asthma-related medications. All services and incentives were paid by the employer's health

Demographics

A total of 207 patients, 58 (28%) men and 149 (72%) women participated in this project during the study period. Of these, 24 (12%) were black and 183 (88%) were white. The mean age of participants was 41.7 years (men, 40 years; women, 42 years).

Patient's Baseline Characteristics

Inclusion criteria were met by 207 adult patients. Patients were eligible for the clinical group when data were sufficient to classify their asthma severity using NAEPP criteria at baseline and at least one follow-up point (paired comparison); 126

Discussion

In the March/April 2003 issue of the Journal of the American Pharmacists Association (JAPhA),37 we published the results of a 5-year study on the long-term outcomes of a diabetes education and MTM program involving 194 patients. Significant clinical, humanistic, and economic improvements following intervention were demonstrated in that population. Since that time, a number of diabetes programs based on our model have begun in other states and a recent publication in JAPhA38 reported similar

Limitations

The longitudinal analysis of data in this study is subject to the limitations that are typical of studies that lack a randomized control group. Any pre—post study must address inherent potential threats to internal and external validity.40,41 Of particular threat to a study of this type are selection bias and regression-to-the-mean because participation was voluntary. Selection bias from dropouts was addressed by using an intention-to-treat design. Of the 207 patients, 39 (19%) were no longer

Conclusion

A community-based asthma disease management program that provided asthma education, financial incentives, and face-to-face counseling by specially trained community pharmacists resulted in significant improvements in clinical, humanistic, and financial outcomes. After participation in the program, patients were significantly less likely to have an asthma-related ED visit or hospitalization, and the health plans experienced significant reductions in net health care costs.

This simple

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    Disclosure: The authors declare no conflicts of interest or financial interests in any products or services mentioned in this article, including grants, employment, gifts, stock holdings, or honoraria.

    Acknowledgments: To Daniel G. Garrett, MS, FASHP, Senior Director Medication Adherence Programs, and Benjamin M. Bluml, BPharm, Vice President for Research, the American Pharmacists Association (APhA) Foundation, for review of this manuscript.

    Funding: Data analysis conducted through the APhA Foundation with funding from GlaxoSmithKline.

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