Descriptive Analysis of Quality Outcomes for Primary Care Clinical Pharmacy Service (PCCPS) Interventions

Purpose: To investigate alternative methods for capturing value of Primary Care Clinical Pharmacy Service (PCCPS) at Kaiser Permanente Colorado utilizing documented clinical outcomes in the literature and applying them to PCCPS specialists daily interventions.

Methods: A Quality Committee was formed to explore novel ways to capture value associated with PCCPS daily interventions that included impact on quality based outcomes. The committee focused on three main intervention types: hypertension, hyperlipidemia, and osteoporosis. In 2010, 3891 patients were identified from an internal database and were matched to pre-designated goals for each disease state: blood pressure <140/90, LDL decreased by 40 mg/dL, or initiation of an anti-osteoporotic drug. Utilizing available peer-reviewed literature and reported costs for cardiovascular procedures, heart attacks, strokes, and fractures prevented, the economic impact was calculated for patients that met the respective disease state metric. Mortality reduction was also analyzed for hypertension. 

Results: PCCPS achieved blood pressure <140/90 in 3334 patients resulting in a predicted 125 cardiovascular events and eighty deaths avoided over ten years and five strokes avoided per year.  Sixty-five patients on statin therapy achieved ≥ 40mg/dL LDL reduction resulting in a predicted two major cardiovascular or cerebrovascular events avoided per year.  Anti-osteoporotic drugs were initiated in 492 patients > 65 years old status post-fracture resulting in a predicted fifty-six fractures avoided (six hip, thirty-six vertebral, fourteen non-vertebral).  A $919,000 annualized return on investment, defined as economic impact of event avoidance minus significant treatment costs of intervention, was calculated ($593,000 hypertension, $38,000 hyperlipidemia, $288,000 osteoporosis).

Conclusion: Utilizing available literature and reported costs, PCCPS interventions can have a favorable quality outcome and economic impact on hypertension, hyperlipidemia, and osteoporosis.