Class of 2011 Abstract / OBJECTIVES: To examine the effects of pharmacist-provided direct patient care with consideration to the patients’ socioeconomic status as determined by the patients’ health insurance. METHODS: A meta-analysis was conducted to evaluate the effects of pharmacist-provided direct patient care on different socioeconomic populations as determined by the patients’ health insurance by including results from several independent randomized control trials. A standardized and tested data extraction form was used to collect primary data on outcome category (therapeutic, safety, and humanistic), disease category (diabetes, hypertension, cardiovascular, dyslipidemia, asthma, and other), insurance status (Medicaid, Medicare, Veterans Affairs/ Department of Defense, private and uninsured), and outcome measures. The potential for bias data were analyzed by calculating a total potential for bias score and by construction a forest plot ordered by bias score. RESULTS: Twenty-two studies were included in the meta-analysis. The insurances most often reported were Medicaid (13.6%), Medicare (18.2%), the Veterans Affairs/ Department of Defense (VA/DoD) (41%), and private insurance (27.2%). All insurance groups benefited from pharmacist intervention (p<0.01). The Medicare patients benefited the least from the pharmacist interventions [standard mean difference (SMD) = 0.21], and the benefit of intervention was significantly less than the benefit for subjects having Medicaid, Private Insurance or VA/DoD coverage (p<0.02). CONCLUSION: While patients in all insurance type benefited from pharmacist intervention, Medicare patients seemed to benefit the least; further studies are needed to verify the findings and to explore why the benefit is less than for other groups.

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This thesis discusses the evolution of the role of the pharmacist in U.S. health care delivery from its early origins to modern day practice. Public policy, education and licensing requirements, and technological advances have substantially shaped the role of the pharmacist and what health care services they provide. Where pharmacists once provided direct patient care when formal modes of pharmacist professionalization did not exist, post-WWII mass production of pharmaceuticals confined pharmacists to dispensing and distribution duties that did not fully utilize their drug knowledge. Consequently, pharmacy educators and leaders have pushed pharmacy practice into an era of “pharmaceutical care,” emphasizing direct patient care activities and the employment of pharmacists’ drug expertise. Pharmacists today have moved back into clinical roles, participating in patient care activities alongside other health care professionals—sometimes even providing primary care services. Due to the U.S.’s growing dependence of prescription drugs and the American public’s continuous demands for high quality care, greater access to health care services, and containment of health care costs, pharmacists will likely acquire greater responsibilities in direct patient care.