This project promotes the Institute of Medicine's six goals in evidence based medicine: patient centeredness, effectiveness, efficiency, safety, timeliness, and equitability.8 LDL, A1C, and BP were chosen as objective measures to determine outcomes results. These chronic disease markers were chosen because pharmaceutical counseling has often been suggested as a way to combat medication noncompliance in the outpatient primary care setting. For example, one study showed that pharmaceutical counseling actually reduced LDL, glucose, and blood pressure readings in patients in an outpatient setting .9

  A survey form was chosen as a method to evaluate patients' satisfaction with SafeMed pharmaceutical counseling. These forms were given to patients at the time of the return visit with the nurse practitioner or physician. Patients were given an opportunity to fill out the questions on the form. The form was kept simple as it was filled out in the presence of the provider. Patients were asked if they found the counseling helpful to understand their medication regimen. Patients were asked if their medication questions were adequately addressed at the time of their consult. Patients were also asked if they had changed the time of the day they take their medications for greater efficacy. Finally, patients were given an opportunity to comment on their individualized drug therapy counseling.

Subject selection

  The criterion for selecting patients for pharmaceutical counseling was based on the following: patients on four or more medications that had any questions or doubts about their medications with the primary care provider. As discussed above, polypharmacy presents a great risk for medication nonadherence, and therefore polypharmacy was used as the inclusion criteria.

  These referrals began in September 08 until March 09. These patients range in age from 60 and above. Patients were asked at the time of their visit with their primary care if they were interested in this counseling. Informed consent was given, and patients were then referred to this telephone pharmaceutical counseling program. Exclusion criteria included those patients who did speak English, as no translator was available for this quality improvement. Patients were also given a form for informed consent at the time of the referral.

Intervention

  A local hospital pharmaceutical counseling, known as SafeMed, was used for telephone based counseling. SafeMed is a hospital based pharmaceutical counseling program for patients being discharged from the local hospital. During the planning stage of this project, it was determined that SafeMed pharmacists could be utilized in the outpatient setting for telephone consulting through referrals from nurse practitioners and physicians in the practice.

  Administrative support of this project was achieved through meetings between the nursing staff, providers, manager, and director of the outpatient clinic. Support of this project was achieved during the planning stages, and the office manager assisted with implementation through quarterly meetings with the office staff reviewing questions of the project implementation. Survey reports were reviewed with both the director and manager of the outpatient clinic. The Hospital's Clinical Improvement Committee was chosen to be an avenue for reporting objective outcome results at the conclusion of the project.

  Pharmaceutical counseling in the elderly is most effective when based on the Beers criteria 10 to determine safety of the medication regimen of the elderly. The telephone counseling focuses on reviewing medication regimens, determining the most appropriate times to take the meds, and clarifying patients' questions or concerns about their specific medication regimens.

  During the pharmaceutical counseling, patients' meds were confirmed with the pharmacist, either on the phone or in a face to face consult. After the consult, the patients were mailed a survey form to evaluate their experience with the counseling session, and were asked to return the surveys to their PCP. The PharmDs also assured that the patients had a follow up appointment with their nurse practitioner or physician. At each follow up visit the nurse reviews the patients' medications, and the nurse practitioner or physician addresses any concerns or questions the patient may have from the counseling.

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