The Pharmaceutical Journal
Vol 268 No 7198 p694-696
18 May 2002

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Disease state management: an integrated approach to providing care

Disease state management is a comprehensive, integrated approach to providing health care, according to Professor KATHLEEN JOHNSON, University of Southern California School of Pharmacy, Los Angeles. It pulls together previous approaches to care in that it optimises costs while considering both clinical and human outcomes.

Conditions that lend themselves to disease state management are chronic conditions that require drug rather than surgical intervention, and where there is agreement on how to manage a condition but variability exists between the practice of individual doctors. This type of management can be conducted at different levels, for example through medical insurance health plans, by hospitals or individual doctors, and through pharmacies. Pharmacists have an important role to play in disease state management, Professor Johnson believes. In hospitals, this includes ensuring that treatment guidelines are followed, the most effective drugs are used, and that patients are given appropriate medicine and advice.

An example of disease state management she described examined the impact of following guidelines for treating community-acquired pneumonia in 61 hospitals. "The study allowed us to provide member hospitals with information to see how they were doing in meeting core performance levels," she said. The study involved 2,323 patients with pneumonia. Poorer patient outcomes were found when the initial antibiotic prescribed was changed or when the first dose of antibiotic was given more than eight hours after admission. Nearly all (92 per cent) hospitals gave the first dose of antibiotics within eight hours of admission but the range was between 0 and 113 hours. Three different treatment guidelines were available at the time of the study and 83 per cent of patients were treated according to one of these guidelines.

"Hospital pharmacists could play a larger role in checking the right antibiotics are given, according to guidelines, and ensuring that drug treatment is given as quickly as possible," Professor Johnson said.

Disease state management could also be used in community pharmacy. Professor Johnson described an asthma management programme. Its goals had been to expand the role of pharmacists while increasing patients' quality of life and compliance.

Pharmacists undertook four consultations each year during which time they had to ensure that patients knew how to use their inhaler properly, how to avoid triggers, that the patients care was coordinated with a doctor and that an action plan for worsening asthma was developed. Professor Johnson said that 211 pharmacists had been trained and were now certified to give consultations. Pharmacists are paid $25 per consultation.

This disease state management programme was a success, she said. Overall cost of treating patients had fallen by 40 per cent while increasing patients' quality of life. One of the reasons for reduced costs was that there had been a significant reduction in rescue inhaler use.

In the future, this type of management plan could be extended so that community pharmacists could manage other disease states, such as diabetes, she added.