Managing Outcomes

DECEMBER 01, 2006
James C. McAllister III, MS, FASHP; Pharmacy Times Editor, Health-Systems Pharmacy Section

Pharmacists began talking about clinical outcomes when the term "pharmaceutical care" was described. We talked in terms of assuming responsibility for drug therapy outcomes, and while the concept took us closer to patient-centered roles and responsibilities, I am not sure we really embraced the "assume responsibility for drug therapy outcomes" portion of the pharmaceutical care concept.

I would suggest that, in the past 20-plus years, we have made little progress in adopting a true outcome focus. I am aware of some notable exceptions at selected hospitals, but I believe leaders have failed to inculcate an outcomes focus into pharmacy practice and even less into performance expectations. Hospital executives and physician leaders have not made managing therapeutic outcomes an organizational priority either. Considerable work needs to be accomplished before we truly take the plunge to optimize pharmacotherapeutic outcomes on an individual patient basis. How should we define "optimal outcomes"? How will they be measured? Will a standardized approach be adopted nationwide? How can we measure real outcomes if therapy is not completed at discharge? What changes in practice need to take place to document therapeutic plans with outcomes targets? How will the efforts be documented? How will the results be used? Some of these questions have been answered, but only by a relatively few forward-thinking practitioners and health systems. Given all this, we can afford to continue our procrastination, right? Wrong!

Many factors will promote clinical outcomes measurement adoption as a priority. Patients are becoming increasingly savvy consumers who rely less on word-of-mouth referrals (by physicians or friends) and more on comparative outcomes data available in the public domain. Insurance companies and other payers will have a profound impact on assuming an outcomes focus as the "pay for performance" phenomenon expands. Undoubtedly, pharmaceutical companies will jump on board and tout their products as having superiority over products offered by their competitors.

In a recent survey of 50 health care systems, hospital executives reported that they will make significant investments in their information technology systems for measuring and reporting clinical outcomes. It seems to me the time has arrived to invest pharmacy resources in developing plans to implement comprehensive drug therapy outcomes measurement services. We have great opportunities to develop new tools and systems, conduct clinical research to compare alternatives, and plan documentation strategies that further underscore the need for and value of comprehensive pharmacy services.

We must seize the opportunity now, unless we would prefer other providers, the pharmaceutical industry, information technology staff, or outside consultants to do it for us. What do you think?

Mr. McAllister is director of pharmacy at University of North Carolina (UNC) Hospitals and Clinics and associate dean for clinical affairs at UNC School of Pharmacy, Chapel Hill.