The Asheville Project: Clinical and economic outcomes of a community-based long-term medication therapy management program for hypertension and dyslipidemia

Abstract

ObjectiveAssess clinical and economic outcomes of a community-based, long-term medication therapy management (MTM) program for hypertension (HTN)/dyslipidemia. DesignQuasi-experimental, longitudinal, pre-post study. Setting12 community and hospital pharmacy clinics in Asheville, N.C., over a 6-year period from 2000 through 2005. ParticipantsPatients covered by two self-insured health plans; educators at Mission Hospitals; 18 certificate-trained pharmacists. InterventionsCardiovascular or cerebrovascular (collectively abbreviated as CV) risk reduction education; regular, long-term follow-up by pharmacists (reimbursed by health plans) using scheduled consultations, monitoring, and recommendations to physicians. Main outcome measuresClinical and economic parameters. ResultsSufficient data were available for 620 patients in the financial cohort and 565 patients in clinical cohort. Several indicators of cardiovascular health improved over the course of the study: mean systolic blood pressure, from 137.3 to 126.3mm Hg; mean diastolic blood pressure, from 82.6 to 77.8mm Hg; percentage of patients at blood pressure goal, from 40.2% to 67.4%; mean low-density lipoprotein (LDL) cholesterol, from 127.2 to 108.3 mg/dL; percentage of patients at LDL cholesterol goal, from 49.9% to 74.6%; mean total cholesterol, from 211.4 to 184.3 mg/dL; and mean serum triglycerides, from 192.8 to 154.4 mg/dL. Mean high-density lipoprotein (HDL) cholesterol decreased from 48 to 46.6 mg/dL. The CV event rate during the historical period, 77 per 1,000 person-years, declined by almost one-half (38 per 1,000 person-years) during the study period. Mean cost per CV event in the study period was $9,931, compared with $14,343 during the historical period. During the study period, CV medication use increased nearly threefold, but CV-related medical costs decreased by 46.5%. CV-related medical costs decreased from 30.6% of total health care costs to 19%. A 53% decrease in risk of a CV event and greater than 50% decrease in risk of a CV-related emergency department (ED)/hospital visit were also observed. ConclusionPatients with HTN and/or dyslipidemia receiving education and long-term MTM services achieved significant clinical improvements that were sustained for as long as 6 years, a significant increase in the use of CV medications, and a decrease in CV events and related medical costs.