The goal of this One reviewer PC was responsible for review- review was to provide information to assist ing titles to generate a list of abstracts for review, Canadian pharmacists in creating a platform and 2 reviewers PC and KG independently from which they can develop their own remuner- assessed abstracts and full-text articles for inclu- ation programs, in collaboration with both public sion.
Disagreements were resolved by discussion, and private payers e. Two inde- pendent reviewers PC, KG extracted data. Due cian with basic training. In consultation with a to the nature of the review subject and the signif- medical librarian, we searched the following data- icant heterogeneity among systems, data were bases from date of inception to June MED- compiled qualitatively, and effect measures were This paper was supported LINE, EMBASE, International Pharmaceutical not calculated.
Alberta Health and Wellness Government of Alberta reviewed and made conclusions on the Payers findings from the literature review. In addition, Payers of community pharmacist clinical care the group provided recommendations for devel- services included both government and private oping an action plan to promote remunerated third parties, though the majority of regional or clinical care in Canadian pharmacy practice, national programs involved government payers.
In systems for which private third-party payers provided remuneration, the reasons cited for the Results involvement included the following: the develop- We identified 28 established systems that are ment of mandatory legislation e.
Of All hospital-based systems for the remunera- the remuneration systems identified, 12 were tion of clinical care services were initiated in the developed for community pharmacies, 7 for hospi- early s and have been discontinued, with the tal pharmacy services both inpatient and outpa- exception of those in Japan.
Japan has changed from the model described in The remaining 4 systems were for various sites not the papers retrieved for this review, and fur- specific to a community or a hospital pharmacy. A ther information could not be obtained personal total of 17 systems were established and funded by communication, E.
Akaho, 25 July Most medication therapy management MTM , disease evaluations focused on health provider satisfac- management, or nondispensing services related to tion and program uptake, with clinical and eco- the provision of a medication medication-relat- nomic outcomes rarely evaluated.
MTM typically involved medication Generally, remuneration systems were deter- reviews by pharmacists with the resolution of any mined to be beneficial to patients. No program drug-related problems to optimize drug use. The Washington competency assessments for pharmacists. The capitation In the Iowa Pharmaceutical Care Delivery model, which sets a rate on a per-patient scale, Demonstration Project, the fiscal impact of the was less common. Hence, Primary Care Trusts in England are show- ing interest in Minor Ailment Services as a cost- Evaluation of outcomes effective local health service to meet national Only 14 systems had been evaluated for an effect health targets.
Uptake and sustainability Remuneration rates were highly variable. Only 14 The proportion of pharmacies that enrolled to systems evaluated clinical, economic, or humanis- provide clinical care services was generally high tic outcomes. The few nificantly between systems, despite high initial programs that evaluated clinical and economic uptake.
The percentages of eligible patients who outcomes suggested either neutral or beneficial received an intervention were high for developing effects. These results, similar or were unsure of maintaining accreditation. This review has identified 28 distinct systems In , a report on medication therapy of remuneration for pharmacist clinical care management was prepared for the American services. Implementing a care professionals39 pilot program with participation from all levels of This review, however, was limited by the signif- pharmacists may result in a high initial uptake but icant heterogeneity of identified systems and cor- a low actual output — a trend seen in many of the responding evaluations.
As a result, it provides a existing programs. Despite a wide search, there was a general readily accepted and maintained, implementation paucity of information on both current and dis- costs should be considered to ensure adequate continued systems, and even fewer evaluative pharmacist training, reasonable documentation studies on economic and patient outcomes. This of interventions, and participation in the certifi- review was limited to systems described in the lit- cation and accreditation processes.
Successful erature and those in multiple pharmacies, and so implementation is of the utmost importance to does not include all systems in existence. Objective: To assess uptake of PCM by pharmacists 3 months after pharmacies were notified of initial patient eligibility. Uptake: Patients: enrolled, At 3 months after initial eligibility, Pharmacists detected an average of 2.
Barriers: Patient access issues Economic: No change for the net number of medications or medication charges, and the number of drugs and charges increased for both patients receiving and not receiving the PCM service.
The Asheville Project —present 6,7,48 Design: Before and after cohort design with comparator group. Objective: To assess clinical, economic, and humanistic outcomes of services provided for 2 groups of patients at 2 different time points short- and long-term.
Economic outcomes: Third-party payer experienced overall decline in mean total direct medical costs during each year of follow-up. Patients with emergency department visits decreased from 9. All objective and subjective measures of asthma control improved and were sustained for as long as 5 years. Home Medicine Review —present 20,29,32,33,36,52 Design: Multistep assessment interviews with stakeholders, pharmacists, consumers, and facilitators. Focus research group of pharmacists. Mail survey of participating pharmacists.
Major motivations for accreditation included professional development and the satisfaction gained from a more active role in consumer care. Economic outcomes: Economic analysis shows cost effectiveness, QALY gains and increasing cost-effectiveness in the future. Pharmaceutical Opinion and Refusal to Dispense —present 25,40,41 Design: Three-month survey period. Objectives: To describe factors associated with billing for pharmaceutical opinions and refusal to dispense.
Employees were more likely to have billed for refusal to fill than for pharmaceutical opinion. A study of the minor ailment service carried out at Keele University found that community pharmacy and practice-based schemes led to a much lower demand on general practitioners by patients to deal with minor conditions. Third-party payer willingness to After reviewing over titles, the benefit pay for clinical care services is crucial to the suc- of clinical care was evident in the literature.
Payers, whether gov- and sustainability. Any remuneration system ernment or employers who make decisions on should be based on a comprehensive business insurance coverage for employees, need to under- model to ensure its viability. Develop a plan to improve uptake by address- services prior to committing to support these ing key barriers e. Pharmacists should provide services and support programs for pharmacists.
Evaluate the remuneration system for econom- part of an employee benefit, exemplified by the ic and patient outcomes after it is established. Asheville Project. In this model, the employers in Rationale: Only one-half of the programs were Asheville realized the associated cost savings of evaluated; often, this evaluation lacks the qual- clinical care and provided comprehensive finan- itative input that generates suggestions for cial support to pharmacists and patients, leading future systems.
Develop a communication strategy to dissemi- benefits to patients. Perhaps, though, many employers would be program depends on involving all participants. Once a remuneration system is developed, the potential cost savings and the financial edge. A launch a marketing campaign based on benefits potential increase in employee participation would of services to engage stakeholders i. As more and other health professionals to communi- patients become involved in wellness programs, cate the benefits of pharmacist care and to physicians may be more willing to collaborate with assist in establishing demand for these services.
Physicians may also be Conclusion more willing to refer patients to receive clinical care Remuneration for pharmacist clinical care is still after pharmacists demonstrate their strengths in a relatively new concept, without long-standing managing chronic care. Even patients, payers, physicians, and pharmacists also with models in place, the geographic locations need to recognize the benefits of clinical care in and settings differ, thus requiring program char- order to generate the demand for these innovative acteristics to meet health care priorities within services, and so encourage third-party reimburse- that particular jurisdiction and population.
Only ment. Stakeholder recognition could be improved with ongoing monitoring and evaluation can we by increasing the marketing of clinical care, such as ensure that the program has the optimal charac- conveying to stakeholders the cost savings and teristics suited to meet the needs of and to improvements in quality of life.
These crucial but improve health outcomes for patients. Develop a payment schedule that provides ade- Chan, Pasutto, Tsuyuki , Edmonton; and the quate remuneration commensurate with the Alberta College of Pharmacists Eberhart , value of the service provided. Edmonton, Alberta. Contact Ross Tsuyuki at Rationale: Previous systems have provided ross. Am J Hosp Pharm ; Marlene Dorgan from the University of Alberta Robinson JD. In: Medicare Benefit Policy Centers for Disease Control and Prevention.
State-based Manual; ; The Asheville Eickhoff C, Schulz M. Pharmaceutical care in community Project: long-term clinical and economic outcomes of a com- pharmacies: practice and research in Germany. Ann munity pharmacy diabetes care program. J Am Pharm Assoc Pharmacother ; Billing for cognitive servic- 7. Ann term outcomes of a community pharmacy diabetes care pro- Pharmacother ; gram.
Ann ects. Iowa Pharmacist ; Pharmacother ; Outcomes- Pharmaceutical Services Negotiating Committee. The new based pharmacist reimbursement: reimbursing pharmacists contract for community pharmacy: a funding reference guide for cognitive services.
J Manag Care Pharm ; Bucks, England: Pharmaceutical Services Negotiating Blue Cross pays for clinical phar- Committee; Special Edition Available: macist services in training hemophiliacs for home care self- www. Pharm Times ; Influence of Collaborative a financial incentive on cognitive services: CARE project clinical pharmacokinetic services. Urbis Keys Young. Evaluation of the home medicines Cost-effectiveness of clinical phar- review program Pharmacy Component : final report.
June J Am Pharm Assoc Washington State ; CARE project: downstream cost changes associated with the Payment provision of cognitive services by pharmacists. J Am Pharm for pharmaceutical services. Virginia Pharmacist ; Assoc ; Young D. Promising results revealed in Mississippi disease National Health Service Scotland. Community pharmacy. Mississippi Division of Medicaid.
Chapter 7. Disease man- Australian Government. Department of Health and agement services. In: Mississippi Division of Medicaid Ageing. Medication management reviews. Pharmacy Manual. Mississippi Division of Medicaid; health. Medicaid to pay Mississippi pharmacists for Medicare Australia. Home disease management. Am J Health Syst Pharm ; Medicines Review. The Asheville project: long-term Evaluation of clinical, humanistic, and economic outcomes of a communi- the Iowa Medicaid pharmaceutical case management pro- ty-based medication therapy management program for asth- gram.
Principal Moore K. Getting paid: billing Medicare for diabetes self- findings from the Washington State cognitive services demon- management training. Fam Pract Manag ;9 6 Manag Care Interface ; Reynolds B. Ohio health agency ties MTM services to new The Pharmacy Guild of Australia. About home medicines CPT codes. American Pharmacists Association. Available: review. Systematic review of pharmacy reimbursement literature. Vogenberg FR, Hull S. Coding for medication therapy Working Paper.
Institute of Health Economics; Medication ther- Benrimoj S, Roberts AS. Providing patient care in commu- apy management services: a critical review. There are many advantages and disadvantages of person-based remuneration system Canavan , pp Advantages of person-based remuneration include reduction of competition among employees, increase technological skills within the organization and increase in job enlargement within the organization.
Firstly, person-based remuneration system reduces competition for positions within the organization since personal qualification and skills are used for promotion. Secondly, Lewis and Podgursky explain that increase in training and education of employee used in compensation broadens the technological skills of employees leading to high experience.
Disadvantages of person-based remuneration system include limited seniority of employees, reduced performance of employees, focuses on the person rather than the. Advance Remuneration And Performance 4 performance of the company. This may highly reduce the performance while the payment remains the same Milkovich, Newman and Gerhart b. Secondly, in the person-based pay system, the seniority is based on personal attributes such as education skills and knowledge and this attracts promotion.
Where there are limited skills and education there is limited seniority hence poor organization structure. Thirdly, the person based remuneration is person-centered and may lead to declining performance due to lack of personal commitment to the performance of the organization.
This may sacrifice the organization at the expense of the employee compensation Ledford
0コメント