Can Clinical Pharmacists Affect SF-36 Scores in Veterans at High Risk for Medication-Related Problems?

• Published in: Medical care Vol. 39; no. 2; pp. 113 - 122
• Main Authors: Malone, Daniel C., Carter, Barry L., Billups, Sarah J., Valuck, Robert J., Barnette, Debra J., Sintek, Charles D., Okano, Gary J., Ellis, Samuel, Covey, Douglas, Mason, Barbara, Jue, Sandra, Carmichael, Jannet, Guthrie, Kelly, Sloboda, Lubica, Dombrowski, Robert, Geraets, Douglas R., Amato, Mary G.
• Format: Journal Article
• Language: English
• Published: United States J. B. Lippincott Williams and Wilkins Inc 01-02-2001; Lippincott Williams & Wilkins, Inc
• Subjects: Aged; Ambulatory Care - psychology; Ambulatory Care - standards; Attitude to Health; Control groups; Drug-Related Side Effects and Adverse Reactions; Female; Health outcomes; Health Services Research; Health Status; Hospitals, Veterans - standards; Humans; Linear Models; Male; Medications; Mental health; Middle Aged; Outcome Assessment (Health Care); Pharmaceutical services; Pharmacies; Pharmacists; Pharmacists - standards; Pharmacy Service, Hospital - standards; Prospective Studies; Psychoeducational intervention; Quality Indicators, Health Care; Quality of Life; Risk Factors; Sample size; Surveys and Questionnaires; Total Quality Management; United States; United States Department of Veterans Affairs; Veterans - psychology; United States
• ISSN: 0025-7079; 1537-1948
• DOI: 10.1097/00005650-200102000-00002

Background. An objective of pharmaceutical care is for pharmacists to improve patients' health-related quality of life (HRQOL) by optimizing medication therapy. Objectives. The objective of this study was to determine whether ambulatory care clinical pharmacists could affect HRQOL in veterans who were likely to experience a drug-related problem. Research Design. This was a 9-site, randomized, controlled trial involving Veterans Affairs Medical Centers (VAMCs). Patients were eligible if they met ≥3 criteria for being at high risk for drug-related problems. Enrolled patients were randomized to either usual medical care or usual medical care plus clinical pharmacist interventions. HRQOL was measured with the SF-36 questionnaire administered at baseline and at 6 and 12 months. Results. In total, 1,054 patients were enrolled; 523 were randomized to intervention, and 531 to control. After patient age, site, and chronic disease score were controlled for, the only domain that was significantly different between groups over time was the bodily pain scale, which converged to similar values at the end of the study. Patients' rating of the change in health status in the past 12 months was statistically different between groups, intervention patients declining less (-2.4 units) than control subjects (-6.3 units) (P <0.004). This difference was not considered clinically meaningful. However, a dose-response relationship was observed for general health perceptions (P = 0.004), vitality (P = 0.006), and change in health over the past year (P = 0.007). Conclusions. These results suggest that clinical pharmacists had no significant impact on HRQOL as measured by the SF-36 for veterans at high risk for medication-related problems.