Pharmacy consultations cut death, hospitalization rates

Patients may be less likely to die or be hospitalized from drug-related complications if they talk to their pharmacists about their prescriptions, new research finds.

Intensive pharmacy consultations for patients taking “high-risk” medications contributed to an 8 percent drop in the number of drug-related deaths over two years, compared to the death rate among similar patients who received minimal or no pharmacy consultations, according to the study.

Rates of hospitalization were also lower among certain groups of patients receiving any type of pharmacy consultation, whether intensive or not, according to Joel W. Hay, Ph.D., of the University of Southern California and colleagues.

The research “implies that the serious national problem of medication-related mortality could be substantially reduced with feasible and tested pharmacist interventions,” Hay says.

Hay and colleagues evaluated three different models of pharmacy consultations to determine how each model might affect death and hospitalization rates among southern California Kaiser Permanente managed care patients with new or changed drug prescriptions.

Under the most intensive model, pharmacists concentrated their consultation efforts on patients who took high-risk drugs with strict dosage ranges or significant adverse effects, like blood thinners or beta-blockers. Both high and low-risk patients received minimal consultation under the second model, and a third group of patients received no consultation unless they asked for advice or pharmacists thought consultation was necessary.

Although intensive consultation reduced death rates among high-risk patients, death rates rose among low-risk patients, who did not receive consultations under this model.

“This result may indicate that even low-risk patients would benefits significantly from pharmacist consultation,” says Hay and colleagues.

Hospitalizations decreased 3 to 5 percent for patients taking certain high-risk drugs and receiving intensive consultations, while urgent and emergency admissions fell among patients receiving minimal consultations, according to the researchers.

A 1998 analysis of 39 studies concluded that adverse drug reactions were the fourth-ranking cause of death in the United States, after heart disease, cancer and stroke. Drug-related illness and death cost an estimated $177.4 billion in 2000.

“These studies of the impact of drug misadventures suggest that pharmacists have tremendous opportunity to affect patient outcomes, including survival and hospitalization,” Hay and colleagues say.

The study was published in the January 2003 issue of the American Journal of Managed Care and supported in part by the Kaiser Permanente Medical Care Program.