Disease management: opportunity for pharmaceutical care?

Most of the efforts to control health care costs in the U.S. have been based upon control of the more expensive components of health care. These efforts have typically failed or fallen short, and some studies even indicate that certain efforts to reduce costs of drugs have significantly increased other medical costs, resulting in overall increases in cost of care. A dramatic new concept called disease management advocates a much broader approach to appropriate treatment of the entire disease process. This often involves shifting care and necessary dollars away from expensive inpatient and acute care to areas such as preventive medicine, patient counseling and education, and outpatient care. This concept has great potential impact regarding drugs and drug therapy because of the implications of appropriate versus inappropriate therapy on the overall cost and clinical outcome of a particular disease. Managed care organizations, prescription benefit management companies, and pharmaceutical manufacturers all are very interested in this promising new paradigm for patient care. Likewise the concept possibly has great implications for pharmacists' successful implementation of pharmaceutical care. In this regard, disease management may have the potential to prove both clinical and economic value of appropriate drug therapy and related pharmaceutical care far beyond the cost of the drug. Some suggestions for pharmacists interested in pursuing the concept of disease management are included at the end of this article.