Pharmacist-led medication management should help with consistency

“If you want someone to do a good job with something, you need to make sure they have the training to do it, make sure that you give them the time to do it and then make sure they’re accountable for doing that job,” says Joshua Pevnick, M.D., M.S.H.S.

Pevnick, an associate professor at Cedars-Sinai Medical Center, led a study of a pharmacist-led program with the goal of reducing hospitalizations from adverse drug events. The results, published last week in JAMA Network Open, were mixed, with the program not producing a statistically significant difference in the overall group of approximately 6,500 patients. But in a subgroup of patients with low medication adherence and literacy, there was a 10.4 percentage point difference in unplanned hospitalization utilization (69 of 240 of usual care patients vs. 64 of 349 in the intervention group).

Pharmacists bring expertise and are often employed by hospitals

and health systems, Pevnick said in an interview with Managed Healthcare Executive. Their role begins with identifying what a patient is taking, then evaluating what they should be taking, and finally ensuring the regimen is practical, factoring in insurance coverage, drug interactions, comorbidities and patient understanding, he said.

“They don’t prescribe or stop prescriptions,” Pevnick noted, “so it’s always going to be OKed by a physician.”

Pevnick noted that some doctors and nurses have the training to do medication management, but it can be difficult to get them to do it consistently given their other responsibilities.

Strangely, he said, it can almost make it worse if doctors and nurses sometimes do a good job of setting up a patient’s medications after they are discharged from the hospital. “You tend to think of it is ‘Well, last time somebody did a great job on it. I hope they'll do it again.” I would say if you want to build a system, you need to have someone who not only has the time and the training, but they [also] need to be accountable to do it.”