Project ImPACT: Hyperlipidemia
Patients were enrolled beginning in March 1996 and final results were published in March 2000. The patient care period lasted 24.6 months.
Following referral and eligibility identification, patients provided the necessary personal and general health information that the pharmacist used to assess their CAD risk. An initial fingerstick blood sample was collected by the pharmacist to generate a fasting lipid profile using the Cholestech LDX Analyzer, a point-of-care testing device in the “waived” category under the Clinical Laboratory Improvement Amendments 14. Results were logged into the patient’s clinical activity record.
After the initial visit and consultation with the pharmacist, patients were asked to make follow-up visits every month for the first 3 months and quarterly thereafter. During these visits, pharmacists employed the APhA Foundation’s Process of Care to engage in collaborative care with the patient and other members of the health care team. The collaborative care framework for the Project ImPACT model includes:
- Establishing a process for the seamless flow of patient care data between and among patients, pharmacists, and physicians.
- Use of point-of-care testing technology to obtain timely, objective information about the patient’s progress in a community practice setting.
- Organizing methods for pharmacists to document, interpret, and report their lipid management interventions.
At each visit, pharmacists used the Cholestech LDX Analyzer to obtain a real-time cholesterol reading that allowed the pharmacist to evaluate the level of hyperlipidemia control. Pharmacist-provided education was tailored to address adherence issues and lifestyle modifications that could improve control. As patients became actively involved in their therapy, treatment plans, and goal setting, physicians were kept informed about clinical progress in these areas:
- Cholesterol test results
- CAD risk
- NCEP goal achievement
Pharmacists made recommendations to physicians as appropriate to optimize medication dosages. The routine monitoring and appointments with the pharmacist created accountability for each patient to become more active self-managers of their high cholesterol.
Payment for Pharmacists’ Services
In the late 1990s, pharmacists were not routinely paid for the clinical services they provided. However within Project ImPACT: Hyperlipidemia, some pharmacies were able to receive compensation for the high level services they provided.
- The average assigned value per visit with the pharmacist was $55, which was broken down as $28 for counseling services and $27 for lipid profiles.
- Of the 232 patients who were asked for payment, 174 (75%) paid an average of $35 per visit.
- Of the 121 third party payers billed for services, 64 (53%) paid an average of $30 for each visit billed. Of these 64 payers, 30 paid for counseling services and 53 paid for lipid profiles (some paid for both).
- Two project sites secured contracts with managed care organizations to deliver services to health plan beneficiaries, one under a fee-for-service arrangement and the other under capitation.