The Asheville Project: Clinical and economic outcomes of a community-based long-term medication therapy management program for hypertension and dyslipidemia
Barry A. Bunting, PharmD; Benjamin H. Smith, PharmD; Susan E. Sutherland, PhD
J Am Pharm Assoc (2003) 2008;48:23-31. doi:10.1331/JAPhA.2008.07140


Objective  Assess clinical and economic outcomes of a community-based, long-term medication therapy management (MTM) program for hypertension (HTN)/dyslipidemia.

Design  Quasi-experimental, longitudinal, pre—post study.

Setting  12 community and hospital pharmacy clinics in Asheville, N.C., over a 6-year period from 2000 through 2005.

Participants  Patients covered by two self-insured health plans; educators at Mission Hospitals; 18 certificate-trained pharmacists.

Interventions  Cardiovascular or cerebrovascular (collectively abbreviated as CV) risk reduction education; regular, long-term follow-up by pharmacists (reimbursed by health plans) using scheduled consultations, monitoring, and recommendations to physicians.

Main outcome measures  Clinical and economic parameters.

Results  Sufficient data were available for 620 patients in the financial cohort and 565 patients in clinical cohort. Several indicators of cardiovascular health improved over the course of the study: mean systolic blood pressure, from 137.3 to 126.3 mm Hg; mean diastolic blood pressure, from 82.6 to 77.8 mm Hg; percentage of patients at blood pressure goal, from 40.2% to 67.4%; mean low-density lipoprotein (LDL) cholesterol, from 127.2 to 108.3 mg/dL; percentage of patients at LDL cholesterol goal, from 49.9% to 74.6%; mean total cholesterol, from 211.4 to 184.3 mg/dL; and mean serum triglycerides, from 192.8 to 154.4 mg/dL. Mean high-density lipoprotein (HDL) cholesterol decreased from 48 to 46.6 mg/dL. The CV event rate during the historical period, 77 per 1,000 person—years, declined by almost one-half (38 per 1,000 person—years) during the study period. Mean cost per CV event in the study period was $9,931, compared with $14,343 during the historical period. During the study period, CV medication use increased nearly threefold, but CV-related medical costs decreased by 46.5%. CV-related medical costs decreased from 30.6% of total health care costs to 19%. A 53% decrease in risk of a CV event and greater than 50% decrease in risk of a CV-related emergency department (ED)/hospital visit were also observed.

Conclusion  Patients with HTN and/or dyslipidemia receiving education and long-term MTM services achieved significant clinical improvements that were sustained for as long as 6 years, a significant increase in the use of CV medications, and a decrease in CV events and related medical costs.

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Cranor CW, Bunting BA, Christensen DB.  The Asheville Project: Long-term clinical and economic outcomes of a community pharmacy diabetes care program J Am Pharm Assoc.  2003;43:173–84.[CrossRef]
Bunting BA, Cranor CW.  The Asheville Project: Long-term clinical, humanistic, and economic outcomes of a community-based medication therapy management program for asthma J Am Pharm Assoc.  2006;46:133–47.
 Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III).  JAMA.  2001;285:2486–97.[PubMed]
Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 (Express) Report.  JAMA.  2003;289:2560–72.[PubMed]
Pearson TA, Blair SN, Daniels SR, et al. AHA guidelines for primary prevention of cardiovascular disease and stroke: 2002 update: Consensus panel guide to comprehensive risk reduction for adult patients without coronary or other atherosclerotic vascular diseases.  Circulation.  2002;106:388–91.[PubMed]
 Bureau of Labor Statistics. Consumer price index for medical care (series ID: CUUROOOOSAM). Accessed at http://bls.gov, July 1 2006.
 American Heart Association. Heart disease and stroke statistics: 2007 update. Dallas:  American Heart Association;  2007.
Bluml BM, McKenney JM, Cziraky MJ, et al. Pharmaceutical care services and results in Project ImPACT: Hyperlipidemia.  J Am Pharm Assoc.  2000;40:157–65.
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