1050. VA Enhanced Pharmacy Outpatient Clinic (EPOC) Study: Preliminary Results
Peter J Kaboli, MD, MS, University of Iowa and REAP Program for Interdisciplinary Research in Health Care Organization, Iowa City VAMC, BL Carter, University of Iowa and REAP Program for Interdisciplinary Research in Health Care Organization, Iowa City VAMC, EA Chrischilles, University of Iowa and REAP Program for Interdisciplinary Research in Health Care Organization, Iowa City VAMC, RI Shorr, University of Tennessee, J Ness, University of Iowa and REAP Program for Interdisciplinary Research in Health Care Organization, Iowa City VAMC, A Bhattacharyya, University of Iowa and REAP Program for Interdisciplinary Research in Health Care Organization, Iowa City VAMC, GE Rosenthal, University of Iowa and REAP Program for Interdisciplinary Research in Health Care Organization, Iowa City VAMC

Objectives: Determine the efficacy of a collaborative phamacist-physician (PharmD-MD) intervention in older veterans at high risk for adverse drug events (ADEs).

Methods: The sample included 493 primary care patients 65 years and older receiving prescriptions for > 5 medications. Patients were randomized to usual care or to the intervention, which included a structured medication history and medical records review. Therapeutic recommendations were developed and presented to patients’ primary care providers. Study endpoints were assessed at baseline and 3 months.

Results: Patients (mean age, 74 years; 98% male) were taking a mean of 13.7 ± 4.9 medications at baseline. At 3 months, the mean number of medications had decreased slightly in both intervention and control patients (1.0 vs. 0.1; p=.08); 22% of patients in both groups reported one or more ADEs (p=.97). No differences (p>.1) were observed between the groups in health-related quality of life (as measured by the SF-8), symptoms, patient satisfaction, medication knowledge, or VA and non-VA healthcare utilization. Provider surveys indicated the intervention was well accepted by 80%, and 77% indicated that they would refer patients to such a service.

Conclusions: Although well-accepted by providers, a collaborative PharmD/MD intervention to improve prescribing resulted in no significant impact on the occurrence of ADEs, healthcare utilization, and other endpoints. The lack of measureable effect may reflect the one-time nature of the intervention or concurrent institutional patient safety initiatives.

Impact: These findings suggest that more intensive interventions to improve medication prescribing in high risk elderly veterans may be necessary.