How Specialty Pharmacies Influence Patient Outcomes

Outcomes are the ultimate measuring stick for specialty pharmacies, because they are intimately tied to patient care. Specialty pharmacy serves a patient population that would otherwise be lost without the service and care provided by these pharmacies.

Frequently, the “high touch” focus that specialty pharmacies are able to place on their patients cannot be replicated by other pharmacies, or even some medical offices. This focus allows patients to achieve results that are expected by their drug therapy.

Patients achieve results when complex therapy is expertly guided by a specialty pharmacy with regards to storage, administration, and side effect management. Patients will also be compelled to work towards positive outcomes when they see the improvements on their quality-of-life.

For example, those suffering from rheumatoid arthritis are driven to remain compliant because their health and ability to lead a normal life is directly related to their ability to walk and use their hands. Patients with rheumatoid arthritis care about their health outcome.

Doctors care about their patient’s health, and are invested in the health outcomes of their patients. If a doctor cannot see the benefits of drug therapy, then they may be less apt to prescribe the drug.

If the physician does not see the benefit of the patient receiving care from a specialty pharmacy, then the specialty pharmacy is not doing a proper job. Specialty pharmacy can provide benefit to medical providers by communicating when milestones, or even basic progress, is achieved to the doctor or medical staff.

A doctor’s reputation is impacted by the level of health and wellness their patients receive. A patient who experiences significant benefits or improvements in health can be a great advertisement for the prowess of a physician.

Clearly, physicians are aligned to appreciate the benefit of positive health outcomes that their patients experience. When patient care can be proven effective, benefits are realized among patients, doctors, pharmacies, payers, and drug manufacturers.

For pharmacies, measuring outcomes is a critical step in demonstrating their ability to provide patient care that creates positive clinical outcomes, and adds value by proving the pharmacy’s competency in managing disease states.

Pharmacies that track and drive outcomes will be perceived as more valuable partners to payers, who will trust the pharmacy’s professional expertise in managing their patients. Additionally, these pharmacies will benefit from maintaining lines of business with their partners, and adhering to their contractual obligations to provide appropriate, effective, and thorough care.

As a result of proving their value with positive patient outcomes, pharmacies will be better positioned to maintain current professional partnerships, while expanding and growing their business. In order for patients, doctors, or pharmacies to benefit from outcome management, the proper steps must be taken to ensure that pharmacies are tracking the metrics that produce the best picture of health benefits.

The most critical item to consider and evaluate is clinical response. Clinical response can involve activities of daily living, including the ability to walk up or down stairs, the dexterity to tie your shoes, or the capability to consume a meal with family.

For a pharmacy to properly measure a clinical response, it is important to first obtain a baseline, or a measurement of typical patient performance for a given action or test. Once a baseline is established, a pharmacy can then measure the variation of patient results that may fall below, or rise above their original baseline values.

Additionally, a pharmacy seeking to evaluate clinical response should also consider patient-reported quality-of-life. If a patient can communicate improvements or declines in their daily lives while following drug therapy, the pharmacy can glean better insight on the therapeutic benefit.

This element of clinical response is more difficult to quantify, as it is inherently qualitative, but can nevertheless provide more insight for pharmacists. The use of smart tech in this instance, such as wearable pedometers, smart watches, etc, can provide backing evidence for patient-reported claims.

A separate metric that correlates to outcomes and should be considered closely, is patient adherence to drug therapy. Adherence relates to outcomes because a patient must take the drugs in order to benefit as expected.

An old measurement system of adherence was medication possession ratio (MPR). MPR could result in values greater than 100%, and was not a true measure of whether the patient had the drug when they needed it.

For example, refilling a drug three weeks late could be hidden by three subsequent refills a week early. The better recognized metric has become percentage of days covered, or PDC.

PDC helps to remove ambiguity by simply considering whether a patient had the drug when they were supposed to. The reason adherence is monitored is because it gives support to clinical outcomes.

If the patient reports they are not achieving any benefit, but they also have not refilled the prescription in a few months, then clearly those issues are related. Similarly, if a pharmacy can prove outcomes and show a high rate of PDC, then it is reasonable to find a relation in the metrics. Granted, high PDC does not guarantee positive health outcomes, but it certainly makes them possible.

Ultimately, the value of outcomes will be determined by how applicable they are to real life, how measurable they are, and how quantifiable they are, so that they may be aggregated and examined to produce useable results. Pharmacies must therefore continue to track and measure outcomes, while making an effort to recognize the individual patient’s response to their specialized care plan.

About the Author

John Meehan earned his PharmD degree from Duquesne University in 2010. John worked in retail pharmacy in rural North Carolina before transitioning to a clinical pharmacist position at Chartwell PA in Pittsburgh, PA. John is currently enrolled in the Masters of Science in Pharmacy Business Administration (MSPBA) program at the University of Pittsburgh, a 12-month, executive-style graduate education program designed for working professionals striving to be tomorrow’s leaders in the business of medicines.