Managing Outcomes

Pharmacists began talking aboutclinical outcomes when theterm "pharmaceutical care"was described. We talked in terms ofassuming responsibility for drug therapyoutcomes, and while the concepttook us closer to patient-centeredroles and responsibilities, I am not surewe really embraced the "assumeresponsibility for drug therapy outcomes"portion of the pharmaceuticalcare concept.

I would suggest that, in the past20-plus years, we have made littleprogress in adopting a true outcomefocus. I am aware of some notableexceptions at selected hospitals, but Ibelieve leaders have failed to inculcatean outcomes focus into pharmacypractice and even less into performanceexpectations. Hospital executivesand physician leaders have not mademanaging therapeutic outcomes anorganizational priority either.Considerable work needs to be accomplishedbefore we truly take the plungeto optimize pharmacotherapeutic outcomeson an individual patient basis.How should we define "optimal outcomes"?How will they be measured?Will a standardized approach be adoptednationwide? How can wemeasure real outcomes iftherapy is not completed atdischarge? What changes inpractice need to take place todocument therapeutic planswith outcomes targets? Howwill the efforts be documented?How will the results beused? Some of these questionshave been answered,but only by a relatively fewforward-thinking practitionersand health systems. Given allthis, we can afford to continueour procrastination, right?Wrong!

Many factors will promoteclinical outcomes measurementadoption as a priority.Patients are becoming increasinglysavvy consumers who rely less onword-of-mouth referrals (by physiciansor friends) and more on comparativeoutcomes data available in the publicdomain. Insurance companies andother payers will have a profoundimpact on assuming an outcomesfocus as the "pay for performance"phenomenon expands. Undoubtedly,pharmaceutical companies will jumpon board and tout their products ashaving superiority over productsoffered by their competitors.

In a recent survey of 50 health caresystems, hospital executives reportedthat they will make significant investmentsin their information technologysystems for measuring and reportingclinical outcomes. It seems to me thetime has arrived to invest pharmacyresources in developing plans to implementcomprehensive drug therapy outcomesmeasurement services. Wehave great opportunities to developnew tools and systems, conduct clinicalresearch to compare alternatives,and plan documentation strategiesthat further underscore the need forand value of comprehensive pharmacyservices.

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

Mr. McAllister is director of pharmacyat University of North Carolina (UNC)Hospitals and Clinics and associatedean for clinical affairs at UNCSchool of Pharmacy, Chapel Hill.