Christensen Dale, Trygstad Troy, Sullivan Robert, Garmise Jennifer, Wegner Steven E
Division of Pharmaceutical Policy and Evaluative Sciences, School of Pharmacy, University of North Carolina, Chapel Hill 27599-7360, USA.
Am J Geriatr Pharmacother. 2004 Dec;2(4):248-56. doi: 10.1016/j.amjopharm.2004.12.002.
A drug therapy management service was designed to reduce polypharmacy among Medicaid recipients. This service selectively focused on patients who were high users of prescription drugs and had potential drug therapy problems (PDTPs).
This article reports the results of the first phase of the North Carolina Polypharmacy Initiative. The goals of this study were to determine: (1) the frequency with which recommendations were made by pharmacists in response to targeted profile alerts aimed at high-risk patients, (2) the frequency and type of drug therapy changes, and (3) the impact on drug-related quality and costs.
A before-after design was used. Nursing home patient profiles with PDTP alerts for specific drugs and drug categories were provided to consultant pharmacists. Targeted patients had received 218 prescription fills within 90 days. Pharmacists were compensated for performing and documenting targeted drug regimen reviews. Interventions of pharmacists and results after physician consultation are described, and cost impacts of changes in drug therapy are reported. Monetary results are shown in year-2002 U.S. dollars.
Prescription profiles were generated from Medicaid claims data and sent to consultant pharmacists for 9208 patients in 253 nursing homes. Pharmacists returned 7548 (82%) of all profiles sent to them. After excluding 1204 patients (13%) who were discharged or deceased, 6344 patients (69%) remained for analysis. At baseline, patients used a mean (SD) of 9.52 prescriptions per month, costing the North Carolina Medicaid program a mean (SD) of 502.96 dollars (309.70). A mean of 1.58 recommendations were offered to prescribers. After physician consultation, > or =1 recommendation was implemented for 72% of patients with a change recommendation, 68% of whom experienced a switch to a lower-cost drug. Drug cost savings were a mean of 30.33 dollars/patient per month. Cost savings from 1 month alone covered the compensation paid to pharmacists for consultation efforts.
This supplemental program of medication reviews for targeted nursing home patients resulted in a reduction of polypharmacy and was beneficial based solely on drug cost savings.
设计了一项药物治疗管理服务，以减少医疗补助领取者的多重用药情况。该服务有针对性地聚焦于那些高处方药物使用者且存在潜在药物治疗问题（PDTPs）的患者。
本文报告了北卡罗来纳州多重用药倡议第一阶段的结果。本研究的目标是确定：（1）药剂师针对针对高危患者的目标概况警报提出建议的频率；（2）药物治疗变化的频率和类型；（3）对药物相关质量和成本的影响。
采用前后对照设计。向顾问药剂师提供具有特定药物和药物类别的PDTP警报的疗养院患者概况。目标患者在90天内接受了218次处方配药。药剂师因进行并记录目标药物治疗方案审查而获得报酬。描述了药剂师的干预措施以及医生咨询后的结果，并报告了药物治疗变化的成本影响。货币结果以2002年美元显示。
从医疗补助报销数据中生成处方概况，并发送给253家疗养院的9208名患者的顾问药剂师。药剂师返回了发送给他们的所有概况中的7548份（82%）。排除1204名（13%）出院或死亡的患者后，6344名患者（69%）留作分析。基线时，患者每月平均（标准差）使用9.52张处方，北卡罗来纳州医疗补助计划平均（标准差）花费502.96美元（309.70美元）。平均向开处方者提供了1.58条建议。医生咨询后，对于72%有变更建议的患者，≥1条建议得到实施，其中68%的患者改用了成本更低的药物。药物成本节约平均为每位患者每月30.33美元。仅1个月的成本节约就覆盖了支付给药剂师的咨询工作报酬。
这项针对目标疗养院患者的补充药物审查计划减少了多重用药情况，仅基于药物成本节约就具有益处。
