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