Kaiser Permanente Launches Study on Patient Counseling
Gebhart, Fred, Drug Topics
With the coming of mandatory counseling in California, Kaiser Permanente and the University of Southern California School of Pharmacy are taking a hard look at how--or if--patient counseling really affects outcomes and costs. The two-year study covers the 2.3 million members of Kaiser Permanente Medical Care Program's Southern California Region.
"Everybody believes that patient counseling is a better model than no counseling!," explained Jeff McCombs, USC assistant professor of pharmaceutical economics and policy, "but no one really knows. Counseling has never been studied rigorously."
Most earlier counseling studies, he pointed out, have looked at patient perceptions of care or intervention in specific disease states such as diabetes or hypertension. The Kaiser-USC program is the first large-scale investigation of the connections between types of patient counseling, patient outcomes, and total cost of care.
McCombs divided Kaiser's patient population into three study groups. Sixty percent of patients will receive state-mandated counseling on every new or changed script. Twenty percent will receive what he is calling the Kaiser model, intensive counseling for a limited number of high-risk patients. Lower-risk patients will not be counseled unless they request it. The two high-risk groups are polypharmacy patients taking five or more different medications within a 12-month period and patients taking at least one of 74 target drugs.
TARGET DRUGS: Target drugs include seizure disorder products, cardiovasculars, calcium channel blockers, beta blockers, anticoagulants, antidiabetic agents, benzodiazepines, NSAIDs, asthma meds, and metered dose inhalers for asthma.
Based on a presurvey study of patient records, 19% to 34% of patients (depending on the facility) fall into the polypharmacy group; of 14% to 31% of patients are currently using one or more target drugs; 8% to 16% fall into both high-risk groups.
A 20% control group will receive counseling at the pharmacist's discretion or by patient request, the standard of care in California before mandatory counseling began on Nov. 1. The state board of pharmacy granted an exemption from mandatory consultation in order to include both control and selective counseling groups.
The counseling exemption has drawn fire from the California Pharmacists Association. …