Frequency and Characteristics of Cognitive Services Provided in Response to a Financial Incentive

Abstract

ObjectiveTo determine the effects of a financial incentive on the number and types of cognitive services (CS) provided by community pharmacies to Medicaid recipients in the State of Washington. DesignProspective randomized trial. CS were reported using a problem-intervention-result coding system over a 20-month period. Setting and SubjectsPharmacists practicing in 110 study (financial incentive) and 90 control community pharmacies. ResultsStudy pharmacists documented an average of 1.59 CS interventions per 100 prescriptions over a 20-month period, significantly more than controls, who documented an average of 0.67 interventions (P < .05) per 100 prescriptions. One-half (48.4%) of all CS were for patient-related problems, 32.6% were for drug-related problems, 17.6% were for prescription-related problems, and 1.4% were for other problems that did not involve drug therapy. A change in drug therapy occurred as a result of 28% of all CS documented in this demonstration. Changes were rarely (2.4%) due to generic or therapeutic substitution and almost always (90%) followed communication with the prescriber. The average self-reported time to perform CS was 7.5 minutes; 75% of interventions were ≤ 6 minutes. Considerable differences existed between study and control groups in the types of problems identified, intervention activities performed, and results of interventions. ConclusionA financial incentive was associated with significantly more, and different types of, CS performed by pharmacists.