| This study investigated the impact of cognitive service interventions provided by pharmacists to Medicaid patients. Cognitive services are services provided by pharmacists that require clinical rather than technical judgment (e.g. patient education or screening prescriptions for improper dose). Data come from the Cognitive Activities and Reimbursement Effectiveness Project and Washington State Medicaid. There were three groups of pharmacies; a group that was paid to provide and document cognitive services, a group that was not paid but did document the provision of cognitive services, and a control group that was matched to patients in the paid and nonpaid groups. The index event was the cognitive service for the paid and nonpaid groups, and a matched prescription for the control group. Data were collected for six months of baseline and six months of follow-up. The patient was the unit of analysis; there were 992 patients from the paid group pharmacies, 554 from the nonpaid and 6,021 from the control group. Data were analyzed using SUDAAN software to account for inherent clustering by pharmacy. The outcomes of interest were (1) medication noncompliance, (2) utilization of health care services, and (3) cost of care. The analysis measured outcomes for all patients as well as those associated with target diseases (epilepsy, depression, heart disease, thrombolic disease, hypertension, diabetes and schizophrenia). Patients in the paid and nonpaid groups were 31% less likely to be noncompliant at follow-up (OR = 0.69; 95% Cl 0.51, 0.94) than control group patients. The likelihood of noncompliance decreased with increasing numbers of services per patient; those with five or more were 72% less likely to be noncompliant (95% Cl 0.14, 0.60) versus those with fewer services. Including the cost of payments to pharmacies, the total cost of care was not significantly increased (p {dollar}>{dollar} 0.05) for the paid group patients. The paid and nonpaid group had an increase in prescription cost and use for target diseases (p {dollar}<{dollar} 0.05), but there was a trend (p {dollar}>{dollar} 0.05) toward decreased use of other components of care. Paying for cognitive services may be cost neutral overall, while increasing the likelihood of favorable clinical outcomes through gains in medication compliance rates. |
