Humanistic outcomes

Kozma, C.M., et al., "Economic, Clinical, and Humanistic Outcomes A Planning Model for Pharmacoeconomic Research," Clin. Therapeut., 15, 1121-1132 (1993). 

Humanistic outcomes include measures of the human aspects of care. Specific types of humanistic outcomes include patient satisfaction and health-... 

Kozma CM, Reeder CE, Schultz RM, 1993. Economic, clinical and humanistic outcomes A planning model for pharmacoeconomic research. Clin Ther 15 1121. 

List the advantages and disadvantages of the various methods of measuring humanistic outcomes. 

The third step is to establish a framework to evaluate the question. When establishing the framework, pharmacists need to know some basic facts about the programs and diseases they are studying. Pharmacists undertaking these projects first should prioritize their objectives by determining what interventions and outcomes most need to be evaluated. For example, Cynthia Marshall may wish to determine the effect of her monitoring program on cost of care (an economic outcome), blood pressure (a clinical outcome), and quality of life (a humanistic outcome). 

Many have proposed that evaluation of drug therapy and pharmacists value-added services should include assessments of economic, clinical, and humanistic outcomes. The economic, clinical, and humanistic outcomes (ECHO) model assumes that the outcomes of medical care can be classified along the three dimensions of economic, clinical, and humanistic outcomes (Kozma, Reeder, and Schultz, 1993). Clinical outcomes are defined as medical events that occur as a result of disease or treatment. Economic outcomes are defined as the direct, indirect, and intangible costs compared with the consequences of medical treatment alternatives. Humanistic outcomes are defined as the consequences of disease or treatment on patient functional status or quality of life. All three of these outcomes need to be balanced simultaneously to assess value. 

Cost-utility analysis is used when quality of fife is the most important outcome being examined. This is common in disease states in which how one feels or what one can do is more important than a clinical laboratory value or economic outcome (e.g., chronic diseases such as heart disease, diabetes, arthritis, cancer, or HIV/AIDS). Cost-utility analyses compare the direct and indirect costs of an intervention with some measurable level of humanistic outcome, such quality of life or level of satisfaction. The direct and indirect costs of treatment alternatives again are expressed in monetary terms. The humanistic outcomes associated with each intervention can be expressed as an SF-12 or SF-36 health survey score for quality of life (Ware, 1997), as a satisfaction survey score (Mac-Keigan and Larson, 1989), or as quality-adjusted life-years (QALYs). QALYs represent the number of full years at full health that are valued equivalently with... 

Another area of humanistic outcomes that may be important to measure is patient satisfaction. Satisfaction is defined as the extent to which individuals needs and wants are met. This is finked with attitudes toward the medical care system, as well as expectations and perceptions regarding the quantity and quality of care received. 

In addition to the analysis requested by the HMO, Cynthia is interested in measuring humanistic outcomes and thinks that it would be important to... 

Patient satisfaction and quality of life are the two most common methods of measuring the humanistic outcomes of care. Improvements in patients quality of life have not been consistently demonstrated however, there is evidence that many of these studies purporting to provide pharmaceutical care were in fact disease state management or specific drug-focused programs in which pharmacists did not assume responsibility for all of the patients drug therapy treatment goals. 

Links care to the outcomes of interest to consumers of health care, taking into account the multidimensional nature of quality by including clinical, economic, and humanistic outcomes. 

Unlike asthma, hypertension is a largely asymptomatic disease. As with other asymptomatic diseases, patients with hypertension are often noncom-pliant with their therapy. This presents a challenge for health care practitioners, because chronic uncontrolled hypertension can lead to serious sequelae such as stroke, coronary disease, and cardiac failure. Pharmacists have been shown to have an impact in improving the clinical and humanistic outcomes among patients with hypertension. 

Economic and humanistic outcome evaluations are now made as part of healthcare governance. The information gained from valid outcome measures can be used on a national level to allocate expenditures for treating various sectors of the population (e.g. the elderly, neonates, etc.) or to determine which programs will receive financial resources (e.g. vaccine programs vs. acute influenza treatments). Outcome information can be used to help make decisions regarding the inclusion or exclusion of drugs on formularies. Complete information about the economic, humanistic... 

Table 23.1 provides examples of clinical, economic and humanistic outcomes. Each outcome type is not mutually exclusive, for example pain... 

The important first step in developing a pharmacoeconomic strategic plan is to start by finding out what is currently known about the disease and the economic and humanistic burden that it has on patients, payers and providers. The best place to start is with a review of the literature and the Internet to determine what has already been accomplished. This may entail a review of the epidemiology and clinical aspects of the condition to verify that pharmacoeconomic components would be a worthwhile addition to a clinical program. After this review the pharmacoeconomist should then formulate the plan for measuring economic and humanistic outcome, and this will ultimately become a component of the full development plan. 

External reports are most likely going to be manuscripts submitted to peer-reviewed journals. Placement of pharmacoeconomic articles in nonspecialty journals is important but difficult. Some editors do not understand the intrinsic properties of pharmacoeconomic data, and some reviewers will blindly apply statistical constraints that are inappropriate or not valid to humanistic outcomes (e.g. power calculations to measures of the adverse effects of drugs on QOL measures). 

Orthopedics has recognized the importance of measuring outcomes in terms of quality-adjusted life-years instead of length of implant survival.Similarly, pharmacy must implement software documentation solutions that facilitate outcomes monitoring beyond cost savings. Software is needed with the ability to calculate, in a cost-benefit analysis, the clinical impact of pharmacist interventions as they affect therapeutic, financial, and humanistic outcomes. The current array of products could be better integrated into documentation software to facilitate tabulation of these data. With the power of the Internet to manipulate data in a dynamic database, it would even be possible for hospitals to compare their outcomes on a local, regional, or national basis. Furthermore, the database could... 

One framework for looking at pharmaceutical outcomes—whether these outcomes are positive or negative—is the ECHO (Economic, Clinical, and Humanistic Outcomes) model, proposed by Kozma, Reeder and Schulz. According to this model, three main types of... 

Instead of focusing strictly on the pharmacy profession, the fourth conference addressed the quality of the entire medication-use system. The objectives were to describe—and publicize—the extent of preventable morbidity, mortality, and excess costs resulting from suboptimal medication use to stimulate discussion of the social and economic impact of dysfunction in the medication-use system to develop a reengineered system for medication use that would optimize clinical, economic, and humanistic outcomes to identify strategies that could be used to evaluate and implement the models developed and to foster greater interprofessional collaboration and a shared commitment to optimal medication use. 

For economic outcomes, we can use pharmacoecon-omy as the main tool. " There is a great variety of clinical indicators that we can relate to drugs efficacy and safety. These clinical indicators, obtained with designs from clinical epidemiology (observational and experimental),are excellent to measure clinical outcomes. To obtain indicators for humanistic outcomes, such as satisfaction and quality of life, we have different tools, such as surveys, and different qualitative research methods (interviews, focus groups, etc.). " ... 

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