Pharmacy students teaching prescribers strategies to lower prescription drug costs for underserved patients

Marilyn R Stebbins, Meghan E Frear, Timothy W Cutler, James M Lightwood, Amanda R Fingado, Cindy J Lai, Helene Levens Lipton
Journal of Managed Care Pharmacy: JMCP 2013, 19 (7): 534-41

BACKGROUND: The rising costs of health care and, in particular, prescription drugs remains a challenge. Health professionals' ability to promote cost-effective prescription drug use is critical, yet this subject is not included consistently in the curriculum of most health professional schools. As experts in prescription drug selection, use, and cost, pharmacists are in a unique position to help manage prescription drug regimens for the best therapeutic outcome, while also helping to keep patients' out-of-pocket (OOP) prescription drug costs low. In addition to promoting interprofessional collaboration, pharmacy student-led lectures may provide an effective means to teach prescription drug cost-savings strategies to other health professional students and current prescribers.

OBJECTIVE: To describe and evaluate the impact of a 60- to 90-minute standardized, case-based lecture on prescribers' attitudes and knowledge about drug cost-containment strategies.

METHODS: Four trained pharmacy students delivered a lecture that focused on strategies to help underserved patients with their OOP prescription drug costs. This lecture was given to health professional students and prescribers across disciplines. For purposes of this study, underserved patients included those with no drug insurance, those with limited financial resources who were unable to pay for their prescription drugs, and those whose drug insurance had significant gaps in coverage (e.g., Medicare Part D patients). Lectures targeted future and current prescribers and were delivered in multiple settings (e.g., residents' seminars, medical grand rounds, required health policy courses for medical and nursing students). Pretest/posttest surveys were administered to assess the impact of the lecture on learners' (a) knowledge of strategies to improve underserved patients' access to needed prescription drugs; (b) willingness to address and discuss cost issues with patients; (c) likelihood of collaborating with other health care professionals; and (d) perception of pharmacists as patient advocates. The survey collected demographic information about learners and assessed their knowledge through 5 case-based, multiple-choice questions. The survey also asked learners to rate their agreement with 5 statements using a 4-point Likert rating scale (4 = strongly agree to 1 = strongly disagree). To control for potential test-retest bias for the case-based knowledge questions, an alternate version of the pretest/posttest survey was developed without the pretest knowledge questions included. Learners received either 1 of the 2 surveys randomly before the lecture began and were instructed to complete the pretest portion of the survey before the start of the lecture and to complete the posttest portion of the survey at the conclusion of the lecture.

RESULTS: From October 2010 to June 2012, trained pharmacy students delivered 19 presentations to 626 learners from other health professions. Compared with the baseline, there was a statistically significant increase in the proportion of correct answers for each knowledge-based question after delivery of the lecture (overall significance P less than 0.001). Furthermore, there was a significant increase in the proportion of learners responding that they were more confident in their ability to select prescription drug cost-saving strategies; more likely to consult with other providers to lower OOP prescription drug costs; more likely to consider costs when making prescribing decisions; and more likely to ask their patients about prescription drug affordability (overall significance of P less than 0.05). In addition, after the lecture, more learners felt that pharmacists were patient advocates. Finally, 96% of learners felt that the lecture promoted interprofessional collaboration and would recommend it to other health care professionals.

CONCLUSIONS: This study demonstrates that a single lecture given by pharmacy students to other health care professional students and current prescribers can improve knowledge of prescription drug cost-saving strategies targeted toward vulnerable patient populations and may increase the likelihood of collaboration between prescribers and pharmacists. The format of this lecture is an efficient and effective way to disseminate important and timely policy information to health care professionals.

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