Frequency and characteristics of cognitive services provided in response to a financial incentive

Abstract

Objective: To determine the effects of a financial incentive on the number and types of cognitive services (CS) provided by community pharmacies to Medicaid recipients in the State of Washington.

Design: Prospective randomized trial. CS were reported using a problem-intervention-result coding system over a 20-month period.

Setting and subjects: Pharmacists practicing in 110 study (financial incentive) and 90 control community pharmacies.

Results: Study pharmacists documented an average of 1.59 CS interventions per 100 prescriptions over a 20-month period, significantly more than controls, who documented an average of 0.67 interventions (P < .05) per 100 prescriptions. One-half (48.4%) of all CS were for patient-related problems, 32.6% were for drug-related problems, 17.6% were for prescription-related problems, and 1.4% were for other problems that did not involve drug therapy. A change in drug therapy occurred as a result of 28% of all CS documented in this demonstration. Changes were rarely (2.4%) due to generic or therapeutic substitution and almost always (90%) followed communication with the prescriber. The average self-reported time to perform CS was 7.5 minutes; 75% of interventions were < or = 6 minutes. Considerable differences existed between study and control groups in the types of problems identified, intervention activities performed, and results of interventions.

Conclusion: A financial incentive was associated with significantly more, and different types of, CS performed by pharmacists.