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Interpreting the findings of the IMPROVE study
B L Carter1, D C Malone, S J Billups
1Division of Clinical and Administrative Pharmacy, College of Pharmacy, and Department of Family Medicine, College of Medicine, University of Iowa, Iowa City, USA.
Summary
The IMPROVE study found that pharmacist-led care improved specific health metrics like A1c and LDL cholesterol control in Veterans Affairs Medical Centers. While overall healthcare costs rose, the intervention group experienced a lower cost increase, demonstrating the effectiveness of managed pharmaceutical care.
Area of Science:
- Health Services Research
- Clinical Pharmacy
- Outcomes Research
Background:
- The Veterans Affairs Medical Centers (VAMCs) implemented the Impact of Managed Pharmaceutical Care on Resource Utilization and Outcomes (IMPROVE) study.
- This study was designed as an effectiveness study to examine global outcomes following pharmacist management.
- New methods were developed for identifying high-risk patients, chronic diseases, and evaluating pharmaceutical care delivery within VAMCs.
Purpose of the Study:
- To review findings from the IMPROVE study.
- To discuss future methodologies for enhancing pharmaceutical care research.
- To assess the impact of managed pharmaceutical care on resource utilization and patient outcomes in VAMCs.
Main Methods:
- A randomized controlled trial involving 1054 patients across nine VAMCs.
- Patients were assigned to either an intervention group (n=523) or a control group (n=531).
- Pharmacists documented interventions and patient contacts over a 12-month period.
Main Results:
- No significant difference in patient satisfaction or quality of life between groups.
- Improved measurement of hemoglobin A1c and better control of total and LDL cholesterol in the intervention group.
- Total healthcare costs increased in both groups, but the mean increase was lower in the intervention group ($1020 vs. $1313).
Conclusions:
- Managed pharmaceutical care can lead to improved disease-specific indicators and potentially lower healthcare cost increases.
- The IMPROVE study provides valuable lessons for future research on the effects of clinical pharmacy services on patient outcomes.
- Further research is needed to refine methodologies for measuring the impact of pharmaceutical care.