Cognitive pharmaceutical services in emerging health care systems - New patient medication management and concordance services in community pharmacy

Aim: To develop, implement and evaluate a patient medication management service (PMMS) and a patient medication concordance service (PMCS) in three healthcare models in metropolitan and rural Australia. Methods: Best practice standards and guidelines were developed for the PMMS and PMCS. 54 pharmacists were recruited and trained to deliver these services in nine study sites. The services were then implemented and evaluated on the basis of their clinical and economic impacts. A pre-post paired t-test was carried out as data on controls was limited. Results: Patients receiving a PMMS demonstrated reductions of 3.6% in drug related side effects, 16.6% improvement in symptoms and a 13.7% improvement in compliance. In addition, the PMMS resulted in an annual net saving of $67.85 per patient on the cost of medications (after the cost of professional remuneration had been considered). Trends were also seen in reduced medication use and reduced health system contacts post intervention. The PMCS resulted in improved patient knowledge with patients able to correctly name their medications increasing from 83.8% to 96.4% those able to assign a disease state for their medicines increasing from 87% to 99.9%. The service also resulted in statistically significant (p<0.034) reductions in medication related side effects from 17.6% to 2.7%. Conclusion: The professional pharmacy services developed within this study have demonstrated beneficial clinical impacts in addition to the PMMS resulting in a total saving on medication costs of $67.85 per patient per year. However, savings to the health system are potentially greater if other health related costs such as general practitioner (GP) visits, usage of community health services and medication related hospital admissions are taken into account.