A systematic review of remuneration systems for clinical pharmacy care services

Objective: To provide descriptions of existing remuneration models for pharmacist clinical care services and to summarize the existing evaluations of economic, clinical, and humanistic outcome studies of the remuneration models. Methods: We searched MEDLINE, EMBASE, International Pharmaceutical Abstracts, EconLit, Scopus, Web of Science, Google Scholar, and PubMed from date of inception to June 2006. We also searched the World Wide Web, hand-searched pertinent journals and reference lists, and contacted experts in pharmacy practice research. One reviewer assessed titles and, with a second independent reviewer, assessed abstracts and full-text articles for inclusion and abstracted data. Disagreements were resolved by discussion or by a third independent reviewer. We included English language articles that described or evaluated current remuneration systems for pharmacist clinical care services and that involved a substantial number of pharmacists and that were paid by a third party other than the patient. Due to heterogeneity between systems, data were compiled qualitatively. Then, based on these results, an expert panel developed recommendations for implementing a remuneration model into current pharmacy practice in Alberta. Results: We identified 28 remuneration systems. Most commonly, payers were government agencies, and services were directed at the management of chronic diseases or complex medication regimens. While capitation models were evident, most systems provided payment according to each intervention carried out. Program evaluations were available from 14 models, and in many systems, initial uptake by pharmacists was high, but participation dropped after initial enrolment. Conclusion: To ensure that the provision of clinical care services will provide a sustainable avenue of income for pharmacists and costeffective quality care for patients, a viable business model with additional training and support for pharmacists and ongoing program evaluation is needed. Can Pharm J 2008;141:102-12. Phil Chan We undertook this review to explore the systems of remuneration that exist for pharmacist clinical services. We were especially interested in systems that are well-established and that have been evaluated for impact, economic efficiency, and utilization. Nous avons réalisé un examen des systèmes de rémunération des services cliniques offerts par les pharmaciens. Nous nous sommes intéressés plus particulièrement aux systèmes bien établis, dont l’incidence, la rentabilité et l’utilisation ont été évaluées. Mr. Chan and Dr. Grindrod are co-primary authors on this manuscript. Kelly Grindrod