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Evaluation of CVS Caremark PAH Multi-Disciplinary Collaborative Clinical Program

M. Fargotstein

M. Baydoun

M. Johlie

B. Simpkins

Rebekah Anguiano

J. O'Rourke

D. Frobel


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Conference: 2011 PH Professional Network Symposium

Release Date: 09.22.2011

Presentation Type: Abstracts

M. Fargotstein, Pharm D; M. Baydoun, MSIS; M. Johlie, BA; B. Simpkins, PharmD; R. Hanson, PharmD; J. O'Rourke, RN; D. Frobel, PharmD
CVS Caremark, Northbrook, IL

PURPOSE/OBJECTIVE: The purpose of this study is to determine the results of a pharmacy clinical management program focused on counseling patients and actively intervening with the prescribing physicians for those patients that were identified at being at risk for disease progression.

BACKGROUND: Pulmonary arterial hypertension (PAH), an incurable disease, is characterized by medial hypertrophy, intimal fibrosis, and in situ thrombi in small muscular pulmonary arteries. PAH was considered a rapidly fatal illness with a median survival of 2.8 years in the 1980s when no evidence-based therapies were available1. Since then the treatment of this disease has made tremendous advances, and in the last 10 years the discovery of new medications have positively influenced the prognosis and survival of patients with PAH. The positive effects of a collaborative practice model between pharmacists, nurses and physicians in the management of PAH patients is key to successful patient management and improved patient safety and clinical outcome2.

METHOD: A sample of patients was identified from a CVS Caremark PAH Case Management database. Selection criteria included a clinical intervention by the pharmacy for those PAH patients that were determined to be at risk for disease progression or not benefiting from their current therapies in the period 8/1/2010 - 4/13/2011 based on patients' self-reported ability to perform normal activities, and with both pre- and post- intervention information on breathing capability and symptoms. The intervention results were matched to claims from an internal pharmacy claims database to verify drug and dosage changes. This population was analyzed to determine changes in patient conditions after the intervention. There were 185 unique patients in the study population (mean age = 58.7 years, 76.2% female). The analysis software used was SAS Enterprise Guide v4.1 (SAS Institute, Cary, NC, USA).

FINDINGS: The pharmacy team initiated interactions with 185 patients in the form of counseling or patient education. 77.8% (Cl: 71.8%-83.9%) of this population maintained or improved their breathing capability, and 85.4% (Cl: 80.3%-90.5%) maintained or improved their symptom status. The pharmacy team additionally worked with the prescribing physicians for 22 patients on drug and dosage adjustments. 77.3% (Cl: 58.3%-96.2%) of these patients maintained or improved breathing capability and 90.9% (Cl: 77.9%-104.0%) maintained or improved symptom status.


These results indicate the likelihood of a value in a collaborative multi-disciplinary clinical program showing improvement or lack of worsening of breathing status and symptom status in this patient population. We will continue to implement and evaluate the value of different multi-disciplinary collaborative clinical programs in improving patient outcomes. The results will be compared to a controlled group for more definitive conclusion.


  1. D'Alonzo GE et al. Annals of Internal Medicine 105: 343-49, 1991
  2. Gin-Sing W. Pulmonary arterial hypertension: a multi-disciplinary approach to care. Nursing Standard 24, 38: 40-47, 2010