Chapter 07: Building the Division of Pharmacy: Shifting Perceptions of What Pharmacy Does, Addressing Costs, Measuring Outcomes

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Chapter 07: Building the Division of Pharmacy: Shifting Perceptions of What Pharmacy Does, Addressing Costs, Measuring Outcomes

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Identifier

AndersonR_01_20040518_C07

Publication Date

5-18-2004

Publisher

The Historical Resources Center, Research Medical Library, The University of Texas Cancer Center

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - Building the Institution; Leadership; On Leadership; Understanding the Institution; The Business of MD Anderson; The Institution and Finances; Institutional Processes; The Researcher; Technology and R&D

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

Disciplines

History of Science, Technology, and Medicine | Oncology | Oral History

Transcript

Roger W. Anderson, PhD:

Which is very helpful, and -- because it just always works better, of course, and then there’s a key point in time when my administrative structure changed, too. In 1986.

Lesley Williams Brunet:

To the division.

Roger W. Anderson, PhD:

To the division. And so now, actually, the table at which these budgets are presented and approved, I’m at that table. So I’m one of the seven sort of division heads that approve each other’s budget. Well, it’s a lot easier for me to get those budget approvements when some of the people sitting at the table are the ones that are asking me for the positions.

Lesley Williams Brunet:

Right.

Roger W. Anderson, PhD:

And I don’t have a lot of votes but I have one vote on their budget too, of course, but not that that’s the way you do it, but still, it’s a very easy communication like now being in that structure, and that’s been important.

Lesley Williams Brunet:

Now, is this unique to MD Anderson Oncology or is this a national --

Roger W. Anderson, PhD:

It’s a national desire and some trend but we are relatively way ahead in the completeness of this kind of service. If you would go to Methodist Hospital here or St. Luke’s or Hermann, very big, very active institutions, we have 40 of these positions. They probably at Methodist may have three.

Lesley Williams Brunet:

I was about to say three.

Roger W. Anderson, PhD:

And St. Luke’s may be two and Hermann may be two. So it’s quite advanced. Now, part of the problem that other directors of pharmacy have, and that’s throughout the country, too, not just Houston, because Houston is as advanced, really, as any other major city in the institution -- in the country -- is that administrators in general haven’t been able to understand the importance of these people that are doing something other than dispensing. Because most administrators think of the pharmacy as a place to get drugs distributed from and that’s what they want to pay for. If you say you’re going to help physicians use drugs more -- better, help use drugs better or you know, monitor therapy, even for safety. Now safety has been a big thing that we’ve capitalized on, and we want to, of course. In therapy and cancer areas much more vulnerable to safety issues because the toxicities are so great. So we’ve -- I mean, I’ve capitalized on that every chance I get, but most administrators don’t like to approve positions that are just going to go out, walk around, and help physicians do their job. You know, they say, well, they should be able to do that. But I think the -- we were well on our way anyway, but the thing that helped me do that better than I ever would have imagined was that when I did my graduate study in public health, which I did in 1990 -- or 1989 through 1997, my dissertation really was the documentation of their value. And what I did -- did I explain this to you before, this study? The dissertation study?

Lesley Williams Brunet:

No, I don’t think so.

Roger W. Anderson, PhD:

OK. What I did is measure over a three year period the value that was created by putting these pharmacists in the direct patient care arena qualitatively on drug therapy outcomes and then quantitatively on economic impact. And our qualitative analysis was really the briefer part of that but it was in about nine different therapeutic categories. We measured outcomes and they all got better with the pharmacist than before. But then the economic impact was far beyond my expectations. I’ll give you a copy of this. I published it.

Lesley Williams Brunet:

I think it would be great to have this.

Roger W. Anderson, PhD:

Yeah, I published it. And the outcome economically, after we bought robots and we bought Pyxis machines and we outsourced some of our IV production which was taking us a lot of labor time and we redeployed the pharmacist time and then that became actually a new cost, so in a cost-benefit analysis, I added all that back in, because as we outsource some of the function of the robot did some of the dispensing, we could have just eliminated those positions and had a savings. But I didn’t want to do that because I wanted to move the pharmacist into the clinical. So I had enough autonomy that I was able to do that almost behind the scenes, and then measure the outcome. And we actually had an economic return that was a surprise to me, bigger than I thought it was going to be. And so in 1996, when I completed the study, from 1993, we were spending $18 million a year less on drugs than we were in 1993 and we had all these other growth things happening. So we had an economic return of $18 million a year by what the pharmacists were doing with the physicians on basically prescribing better. And they were determining doses that were more realistic, they were monitoring therapies that didn’t work and discontinuing them rather than just keep it going. They were using more effective doses. Just all sorts of things like that.

Lesley Williams Brunet:

Now this is the pharmaco-- this is when the [pickups 17:43] like Pharmacoeconomics --

Roger W. Anderson, PhD:

Well, you would consider that a pharmacoeconomic kind of study. Yeah. And at the time we were creating a separate section within the pharmacy that was pharmacoeconomics. We actually have changed that title now to pharmaceutical policy and outcomes research. That’s the name of the department now. That’s within pharmacy. And then I work in myself as much as I can. And so that was phenomenal and in fact, on a return on investment ratio, it was 7.9 to 1 so for every $1 invested we had a return of $7.90.

Lesley Williams Brunet:

That’s really impressive.

Roger W. Anderson, PhD:

Right. And that was $18 million a year to the bottom line in ’96. I have projected those numbers through the year 2004 and it’s not as scientific as it was during those years but quite accurately, I believe, that in 2004 the expenditures for drugs here at MD Anderson are this year $40 million less because of what those pharmacists do.

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Chapter 07: Building the Division of Pharmacy: Shifting Perceptions of What Pharmacy Does, Addressing Costs, Measuring Outcomes

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