Bunting Barry A, Cranor Carole W
Department of Pharmacy, Diabetes & Health Education Center, Mission Hospitals, Asheville, NC, USA.
J Am Pharm Assoc (2003). 2006 Mar-Apr;46(2):133-47. doi: 10.1331/154434506776180658.
To assess clinical, humanistic, and economic outcomes of a community-based medication therapy management (MTM) program for 207 adult patients with asthma over 5 years.
Quasi-experimental, longitudinal pre-post study.
12 pharmacy locations in Asheville, N.C. PATIENTS/OTHER PARTICIPANTS: Patients with asthma covered by two self-insured health plans; professional educator at Mission Hospitals; 18 certificate-trained community and hospital pharmacists.
Education by a certified asthma educator; regular long-term follow-up by pharmacists (reimbursed for MTM by health plans) using scheduled consultations, monitoring, and recommendations to physicians.
Changes in forced expiratory volume in 1 second (FEV1), asthma severity, symptom frequency, the degree to which asthma affected people's lives, presence of an asthma action plan, asthma-related emergency department/hospital events, and changes in asthma-related costs over time.
All objective and subjective measures of asthma control improved and were sustained for as long as 5 years. FEV1 and severity classification improved significantly. The proportion of patients with asthma action plans increased from 63% to 99%. Patients with emergency department visits decreased from 9.9% to 1.3%, and hospitalizations from 4.0% to 1.9%. Spending on asthma medications increased; however, asthma-related medical claims decreased and total asthma-related costs were significantly lower than the projections based on the study population's historical trends. Direct cost savings averaged 725 dollars/patient/year, and indirect cost savings were estimated to be 1230 dollars/patient/year. Indirect costs due to missed/nonproductive workdays decreased from 10.8 days/year to 2.6 days/year. Patients were six times less likely to have an emergency department/hospitalization event after program interventions.
Patients with asthma who received education and long-term medication therapy management services achieved and maintained significant improvements and had significantly decreased overall asthma-related costs despite increased medication costs that resulted from increased use.
评估一项针对207名成年哮喘患者开展的为期5年的社区药物治疗管理（MTM）项目的临床、人文及经济效果。
准实验性纵向前后对照研究。
北卡罗来纳州阿什维尔的12家药房。
患者/其他参与者：由两个自保健康计划承保的哮喘患者；使命医院的专业教育工作者；18名获得认证培训的社区及医院药剂师。
由认证哮喘教育工作者进行教育；药剂师定期进行长期随访（健康计划为MTM报销费用），通过定期会诊、监测并向医生提出建议。
1秒用力呼气量（FEV1）、哮喘严重程度、症状频率、哮喘对人们生活的影响程度、哮喘行动计划的制定情况、与哮喘相关的急诊科/医院就诊事件的变化，以及随时间推移哮喘相关费用的变化。
哮喘控制的所有客观和主观指标均得到改善，并持续了长达5年。FEV1和严重程度分级显著改善。拥有哮喘行动计划的患者比例从63%增至99%。急诊科就诊患者比例从9.9%降至1.3%，住院患者比例从4.0%降至1.9%。哮喘药物支出增加；然而，与哮喘相关的医疗索赔减少，且哮喘相关总费用显著低于基于研究人群历史趋势的预测值。直接成本节约平均为每位患者每年725美元，间接成本节约估计为每位患者每年1230美元。因缺勤/无效率工作日导致的间接成本从每年10.8天降至2.6天。项目干预后，患者发生急诊科/住院事件的可能性降低了六倍。
接受教育及长期药物治疗管理服务的哮喘患者取得并维持了显著改善，尽管因用药增加导致药物成本上升，但哮喘相关总体费用显著降低。
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