5/31/2017
Objectives
TreatmentGuidelinesand
DiseaseStateManagement
PresentationDevelopedforthe
AcademyofManagedCarePharmacy
Updated:February2015
PotentialBenefitsofTreatmentGuidelines
Diseasespecificstandards
Improvehealthcareproviderdecisionmaking
Ensureconsistencyinmedicalpracticeand
conformwithevidencebasedmedicine
Ensurequalityofcare
Controlhealthcarecosts
DiseaseStateManagementPrograms
Focus on specific conditions as separate entities
Primarily focus on chronic disease states
Utilize patient data, provide monitoring systems
and feedback mechanisms
Goals
Improve patient outcomes
Reduce health care costs
Obtainageneralunderstandingoftreatment
guidelinesanddiseasestatemanagement
Understandthebenefitsoftreatment
guidelinesinhealthcare
Describethevalueofdiseasestate
managementprograms
DiseaseStateManagement
Acomprehensive,integratedapproachtocare
andreimbursementbasedonthenaturalcourse
ofadisease,withtreatmentdesignedtoaddress
anillnesswithmaximumeffectivenessand
efficiency.
ZitterM.TheGenesisReport/MCx.February1995;1(3):1213.
DiseaseSelectionCriteria
Totalcostofdiseasestate
Diseaseprevalence
Whetherthediseasecanbedefinedby
specificcriteria(i.e.notoverlappingwith
otherdiseases)
Whetherthereisatreatmentorpossible
interventionforthedisease
Whetherthereareopportunitiestoimprove
managementofthedisease
AcademyofManagedCarePharmacy.APharmacistsGuidetoPrinciplesandPracticesofManagedCarePharmacy.1995.
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ExamplesofDiseaseStateManagementPrograms ProgramDevelopment
Asthma Disease state management programs are often
based on treatment guidelines (clinical practice
Coronary Artery Disease guidelines, protocols, algorithms, critical
pathways, care maps)
Diabetes
Consensus groups and statements also
Depression considered
Hypertension Key program components
Peptic Ulcer Disease Patient identification
Intervention protocols
Outcomes management

ClinicalPracticeGuidelines ClinicalPracticeGuidelines

DiseaseState Performance Reference/ DiseaseState Performance Reference/

Measure Guidelines Measure Guidelines
Diabetes A1c<7.5% ADAStandard2015
HeartFailure OnACEI/ARB ACC/AHA
BP<140/90mmHG ADAStandard2015
Onbetablocker ACC/AHA
LDLatgoal ADAStandard2015
Hypertension BP< 140/90mmHg JNC8
CAD OnAntiplatelettx ACC/AHA Hyperlipidemia LDLatgoal ACA/AHA2013
Onbetablocker ACC/AHA Osteoporosis Oncalciumtx AACE
OnACEI/ARB ACC/AHA Onosteoporosis AACE
Onstatin ACC/AHA meds
Stroke OnAntiplatelettx ACCPGuidelines2008

Adherence to Clinical
ImpactonHealthcare Practice Guidelines DSM vs. DRR

Improvement of overall health care LTCfacilitiesw/DSM(107pts)vs.traditionaldrugregimen

Increase in short-term health care costs
Higher prescription drug utilization
Higher number of office visits
Higher number of laboratory tests
Reduction of long-term medical costs
Avoidance of emergency room visits
Avoidance of hospitalizations
review(DRR)(304pts)
AdherencetoClinicalPracticeGuidelinesstatistically
improvedinDSMvs.DRR:
DM HgbA1c*< 7%(86.2%vs.62%),antiplatelettx* (89.7%vs.71%)
CAD ASA/clopidogrel(88.2%vs.56.1%),ACEI/ARB(82.4%vs.40.9%)
HF ACEI/ARB(73.3%vs.44.9%)
Osteoporosis Calciumtx(85%vs.56.3%)
Nostatisticaldifferencebetweengroupsinstroke,HTN,
hyperlipidemiaguidelineadherence

KKHorning,etal.JMCP2007;13(1):2836.
*guideline has been updated since the publication of this study

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Summary References
1.RSHadsal,LJSargent.DiseaseStateManagement.JMCP1995;1(2):128133.
Treatmentguidelineshelpprovidersmaintain 2.MZitter.TheGenesisReport/MCx.February1995;1(3):1213.
consistencyandqualityofcare 3.AcademyofManagedCarePharmacy.APharmacistsGuidetoPrinciplesand
PracticesofManagedCarePharmacy.1995.
Diseasestatemanagementprograms 4.AmericanDiabetesAssociation.Summaryofrevisionsforthe2005clinicalpractice
recommendations.DiabetesCare.2005;28:S4S36.
Basedontreatmentguidelines 5.NationalDiabetesQualityImprovementAlliance.NationalDiabetesQuality
ImprovementAllianceperformancemeasurementsetforadultdiabetes.Approved
Helpimprovepatientoutcomes January21,2005.Availableat:www.nationaldiabetesalliance.org .Accessed
November7,2007.
Helpreduceoverallhealthcarecosts 6.SCSmith,etal.AHA/ACCscientificstatement.AHA/ACCguidelinesforpreventing
heartattackanddeathinpatientswithatheroscleroticcardiovasculardisease:
2001update.AstatementforhealthcareprofessionalsfromtheAmericanHeart
AssociationandtheAmericanCollegeofCardiology.Circulation.2001;104:1577
79.
7.JHirsh,etal.TheseventhACCPconferenceonantithromboticandthrombolytic
therapy:evidencebasedguidelines.Chest.2004;126:172S173S.

References
8.SAHunt,etal.ACC/AHA2005guidelineupdateforthediagnosisandmanagement
ofchronicheartfailureintheadult summaryarticle.Circulation. 2005;112:1825
52.
9.AVChobanian,etal.Seventhreportonthejointnationalcommitteeonprevention,
ThankyoutoAMCPmembers
detection,evaluation,andtreatmentofhighbloodpressure.Hypertension.
2003;42:120652.
10.Thirdreportoftheexpertpanelondetection,evaluation,treatmentofhighblood
JonRosen&DebbieMeyerfor
cholesterolinadults(AdulttreatmentpanelIII) Executivesummary.Bethesda,MD:
NationalInstitutesofHealth.Reportno.:NIH013670.PublishedMay2001. updatingthispresentationfor
11.SMGrundy,JICleeman,CMMerz.Implicationsofrecentclinicaltrialsforthe
nationalcholesteroleducationprogramadulttreatmentpanelIIIguidelines.
Circulation. 2004;110:22739.
2015.
12.Americanassociationofclinicalendocrinologistsmedicalguidelinesforclinical
practiceforthepreventionandtreatmentofpostmenopausalosteoporosis.
EndocrinePractice.2003;9:54564.
13.KKHorning,etal.Adherencetoclinicalpracticeguidelinesfor7chronicconditions
inlongtermcarepatientswhoreceivedpharmacistdiseasemanagementservices
versustraditionaldrugregimenreview.JMCP 2007;13(1):2836.