Advanced Practice Pharmacists: cost of medications prescribed by ClinicaL Pharmacist PractitionErs compared to Primary Care Providers in North Carolina (APPLE-NC)

Abstract

Introduction: There is a need to discover new methods of cost-­‐effective care as the healthcare system transitions to a model emphasizing quality outcomes. Medication prices continue to rise and must be considered when evaluating the cost of new approaches to treatment. Increased utilization of advanced practice pharmacists represents one solution to appropriate medication use in chronic disease state management. However, the effect on the cost of prescribed pharmacotherapy is unknown. Objective: To determine the cost of medications prescribed to patients receiving care from both Clinical Pharmacist Practitioners (CPPs) and Primary Care Providers (PCP: physician, family nurse practitioner, and physician assistant) compared to those just receiving care from PCPs. Methods: This was a retrospective matched cohort analysis. Each cohort was matched by gender, age, and disease states of interest. There were 130 patients total, 65 in each cohort, seen at the University of North Carolina outpatient clinics between November 2008 and November 2011. The primary endpoint was average medication cost per day per patient determined by the average wholesale price (AWP) of prescribed medications. The secondary endpoint was average number of therapy changes per year per patient. Results: There was no statistical difference in the average medication cost per day per patient in the CPP cohort versus PCP cohort ($38.52 vs.$38.23, respectively; p = 0.97). Patients managed by CPPs experienced a higher average number of therapy changes per year compared to patients only managed by PCPs (21.1 vs. 15.5, respectively; p = 0.032). Conclusions: CPPs utilized within the healthcare team did not result in an increased medication cost despite being correlated with more therapy changes.Doctor of Pharmac