Rationale – Why PRISM
US Healthcare spending exceeds $2.7 trillion dollars and makes up 18% of the Gross Domestic Product. Over 74% of office visits result in, or are a result of, medication therapy issues, but there is no routine provision of comprehensive medication optimization and management services that ensures optimal outcomes.
Medications are a cornerstone of the management of most chronic conditions. For patients with chronic diseases, various factors—such as having multiple medical conditions, seeing several providers, taking numerous medications, and having adverse reactions to drugs—can complicate the appropriate use of medications. Over 1.5 million preventable medication adverse events occur annually, 32% of medication related adverse events lead to hospital admission, and drug interactions are an important issue in medication use at home. Furthermore, only 33–50 percent of patients with chronic conditions adhere completely to the medication regimen prescribed by their health care providers. In addition, the healthcare system is being pressed to provide access to care for millions of previously uninsured or underinsured patients in a cost-effective manner. Many of these newly insured patients are also the most vulnerable.
The vulnerable are often medically complex, economically disadvantaged, ethnically diverse, and many possess language barriers. To date, not enough work has been done to target their medication-related issues and to discover effective ways to engage them in health promotion activities. While the nation as a whole has seen dramatic reductions in diseases like hypertension, myocardial infarctions, and dementia, the most vulnerable citizens do not share in the benefits. Such negative clinical outcomes also result in negative economic and humanistic outcomes. For example, the sickest patients become much more expensive because they put off care and prevention until it is too late, driving up health care costs for the entire community.
