This project will evaluate the pilot test of a pharmacy-based patient monitoring (PPM) protocol. The PPM protocol is designed to modify the relationship between the provision of pharmaceutical care and drug utilization outcomes among patients of community pharmacy practitioners. Staff model HMOs have significant organizational advantages that enhance the management of care. However, not all managed care programs that are likely to compete are staff model HMOs. The care of medically indigent and Medicaid patients in rural areas most likely will be provided by health care practitioners associated with one or more IPAs. Unfortunately, IPA HMOs do not have the same degree of control over the practice of the medical and pharmacy providers because they are not HMO employees. It is important to IPA HMO drug benefit administrators to determine whether they can manage the cost and care of their patients in ways similar to staff model HMOs. The experimental design is a pretest-posttest control group experimental trial. Randomly selected moderate-to-severe asthmatics from a north- central Florida IPA HMO will be monitored by pharmacists using the experimental PPM protocol and their outcomes will be compared with an age- sex matched control group's outcomes. The control level of pharmaceutical care is the usual prescribing and dispensing process of community practice. The pharmacy-based patient monitoring (PPM) protocol includes: (a) drug therapy review and assessment based upon asthma treatment guidelines, (b) recommendations and form for collecting relevant patient information, (c) strategies to influence the appropriateness of physician prescribing, (d) guidelines for monitoring patients' clinical and quality-of-life outcomes, and (e) forms for providing feedback to patients and their physicians. The protocol differs from normal community-based pharmacy services because of its added emphasis on monitoring patient outcomes and providing patient-specific advice and feedback to patients and physicians. Experimental and control groups will be compared on a process of care and patient outcome measure, namely drug utilization and quality of life. The primary sources of data are the IPA HMOs automated prescription dispensing data base and surveys of patient's asthma-specific quality of life. Pharmaceutical care in the context of community, ambulatory care has major policy implications and has rarely been explicitly addressed by prior research or health policy analysts as a variable that influences clinical and quality-of-life outcomes.
