INTRODUCTION

Pharmacists are well-trained, yet often underutilized within the primary care delivery system to identify, resolve, monitor and prevent medication-related problems (MRPs). ¹ Medication therapy management (MTM) is a term which describes a broad range of services that are provided by pharmacists to optimize individual patients' therapeutic outcomes. ² The MTM care process includes conducting a comprehensive patient medication assessment to identify appropriateness of drug therapy, developing and documenting a care plan to achieve patient-specific goals of therapy and performing follow-up evaluation to resolve drug therapy problems. When structured to allow patients, pharmacists, physicians, and other caregivers to

ABSTRACT

Purpose: The purpose of this study is to evaluate the impact of a newly implemented pharmacy managed service in a Substance Abuse Residential Rehabilitation Treatment Program (SARRTP) within a Veterans Medical Center setting. Patients receiving residential treatment may have a lapse in primary care services if their primary care provider is based out of a different facility. This can result in undesirable outcomes, including unnecessary emergency department (ED) visits or unaddressed medical needs. Additionally, these patients have often made significant lifestyle modifications that can have a major impact on the treatment of their chronic medical conditions. A pharmacy-managed clinic was created for these patients to provide medication therapy management as appropriate within the scope of a pharmacist.

Methods: A retrospective chart review was performed using the Computerized Patient Record System to assess outcomes of the newly implemented pharmacy managed clinic for SARRTP patients. Institutional Review Board approval was obtained prior to data collection. Outcomes assessed included number of ED visits before and after clinic initiation, as well as number and type of pharmacist interventions. Fisher's exact test was used to determine statistical significance, defined as p<0.05.

Results: Thirty-seven patients were seen in a total of 46 clinic visits over a period of six months. ED visits had a statistically significant decrease of 27.9% following clinic initiation (p<0.05). There was an average of 4.3 problems assessed per patient. Average number of interventions per patient was 2.7 with an average of 3.5 educational topics documented.

Conclusion: ED visits decreased significantly following clinic initiation, resulting in cost savings. Multiple interventions were made through this new clinical service to improve Veteran care. Lifestyle modifications made by this patient population often require therapy adjustments and education to optimize care. This type of innovative clinical service would likely be beneficial for other facilities to consider providing.

A potential case of refeeding syndrome in a patient with severe mental illness

Amber R. DouglassPharmD, BCPS, BCPP, FAAPP,

Eliana SpeyBS, and

Kimberly A. EhrhardPharmD, BCPP

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