Presenting the evidence: a cost-saving pharmacy solution with long-term results.

It sounds counter to logic: an institutional pharmaceutical products provider training its pharmacists for the purpose of reducing or potentially eliminating many of the higher-cost, more-profitable prescription drugs.

But there is a method to our proverbial madness.

NeighborCare recently launched an Evidence Based Medicine training program for consultant pharmacists aimed at saving skilled nursing centers money and decreasing resident adverse drug reactions. The Evidence Based Medicine program, expected to raise the bar for consultant pharmacist nationwide, is modeled after a four-year demonstration project run by two faculty members of the Medical University of South Carolina.

Evidence Based Medicine is an approach to healthcare where medical professionals utilize the best external research (evidence) to supplement their clinical training and expertise. For NeighborCare professional pharmacists who practice in long-term care, evidenced-based medicine means offering the resident the most thorough consultant recommendations and comprehensive care.

In 1999, after consulting with a few local NeighborCare pharmacists in South Carolina, an education program was developed to train skilled consultant pharmacists in pharmacotherapy recommendations and core competency development.

NeighborCare's Clinical Services leadership team concluded that an in-depth educational program could provide substantial savings to nursing facilities and insurance companies while also maximizing outcomes in residents. NeighborCare would provide its skilled nursing facility customers with pharmacists specifically trained in medication utilization, evidence-based recommendations, and industry trends. The result was significant cost-savings, a highly-motivated team of in house pharmacists and a decrease in adverse drug reactions.

A pilot program

In 2000, a pilot Evidence Based Medicine training program commenced in South Carolina. With the few pharmacists based in South Carolina serving as the control group, a goal was set to effectively prove that their interventions could benefit patients, caregivers, nursing facilities and insurance companies alike.

NeighborCare began with a commitment of five staff and four consultant pharmacists to test these theories. On a monthly basis, medication use and cost was measured and reported the number of medications and medication doses per nursing home resident per month; the number of laboratory measurements for narrow therapeutic index drugs per nursing home resident per month; and the cost of all oral medications per nursing home resident per month.

These numbers were compared to national benchmarks, while calculating nursing administration time, Medicaid and Medicare costs and reimbursement rates. All results were statistically processed and reported on a quarterly basis and are included in NeighborCare's Best Practices Recommendations to its skilled nursing facility customers and the attending physicians.

With the initial success of the pilot program, NeighborCare expanded the program to train as many of its consultant and staff pharmacists as possible (based on a strict voluntary basis of enrollment) with a year-long commitment of up to six hours a month.

Better than expected

NeighborCare expected the formalized Evidence Based Medicine training program to attract about 100 consultants. But nearly every full-time consultant and many staff pharmacists have signed on to participate, with enrollment approaching 500 pharmacists.

Partnering with the Medical University of South Carolina, under the oversight of Dr. Ron Nichols, NeighborCare consultants learn how to dialogue and support clinical recommendations appropriately. Project team leaders Dr. Lori Dickerson and Dr. Kelly Jones developed a core curriculum comprised of six modules presented in two parts.

Part one is a study packet and part two is video teleconferenced meetings at various pharmacy sites. The curriculum includes modules dedicated to such topics as Cardiology--anticoagulants and antiplatelet agents, Pharmacotherapy for Dementia and Psychoses, and Pain Management. Upon completion, graduates of the program earn a Certificate of Pharmacists Geriatric Training in Evidence Based Medicine.

NeighborCare has since begun planning of Phase III of the program, hoping to partner with one or more additional medical schools across the United States. In addition, NeighborCare aims to actively involve physicians, physician assistants, and other health care providers in the program so that they can gain the knowledge and understanding of the benefits of EBM in day-today practice.

Roger J. Levitt is vice president of customer support and development for baltimore-based NeighborCare the nation's third-largest long term care pharmacy provider. For more details, contact Dr. 444-5100, 296 or via e-mail at roger.