Isetts Brian J, Schondelmeyer Stephen W, Artz Margaret B, Lenarz Lois A, Heaton Alan H, Wadd Wallace B, Brown Lawrence M, Cipolle Robert J
College of Pharmacy, University of Minnesota, Minneapolis.
College of Pharmacy, University of Minnesota, Minneapolis.
J Am Pharm Assoc (2003). 2008 Mar-Apr;48(2):203-214. doi: 10.1331/JAPhA.2008.07108.
To (1) provide medication therapy management (MTM) services to patients, (2) measure the clinical effects associated with the provision of MTM services, (3) measure the percent of patients achieving Healthcare Effectiveness Data and Information Set (HEDIS) goals for hypertension and hyperlipidemia in the MTM services intervention group in relationship to a comparison group who did not receive MTM services, and (4) compare patients' total health expenditures for the year before and after receiving MTM services.
Prospective study.
Six ambulatory clinics in Minnesota from August 1, 2001, to July 31, 2002.
285 intervention group patients with at least 1 of 12 medical conditions using prestudy health claims; 126 comparison group patients with hypertension and 126 patients with hyperlipidemia were selected among 9 clinics without MTM services for HEDIS analysis.
MTM services provided by pharmacists to BlueCross BlueShield health plan beneficiaries in collaboration with primary care providers.
Drug therapy problems resolved; percentage of patients' goals of therapy achieved and meeting HEDIS measures for hypertension and hypercholesterolemia. Total health expenditures per person were measured for a 1-year period before and after enrolling patients in MTM services.
637 drug therapy problems were resolved among 285 intervention patients, and the percentage of patients' goals of therapy achieved increased from 76% to 90%. HEDIS measures improved in the intervention group compared with the comparison group for hypertension (71% versus 59%) and cholesterol management (52% versus 30%). Total health expenditures decreased from $11,965 to $8,197 per person (n = 186, P < 0.0001). The reduction in total annual health expenditures exceeded the cost of providing MTM services by more than 12 to 1.
Patients receiving face-to-face MTM services provided by pharmacists in collaboration with prescribers experienced improved clinical outcomes and lower total health expenditures. Clinical outcomes of MTM services have chronic care improvement and value-based purchasing implications, and economic outcomes support inclusion of MTM services in health plan design.
（1）为患者提供药物治疗管理（MTM）服务；（2）衡量提供MTM服务所带来的临床效果；（3）衡量MTM服务干预组中达到高血压和高脂血症医疗保健有效性数据和信息集（HEDIS）目标的患者百分比，并与未接受MTM服务的对照组进行比较；（4）比较患者在接受MTM服务前后一年的总医疗支出。
前瞻性研究。
2001年8月1日至2002年7月31日期间，明尼苏达州的六家门诊诊所。
285名干预组患者，根据研究前的健康保险理赔记录，患有12种疾病中的至少一种；在9家未提供MTM服务的诊所中，选取126名高血压对照组患者和126名高脂血症患者进行HEDIS分析。
药剂师与初级保健提供者合作，为蓝十字蓝盾健康计划受益人提供MTM服务。
解决的药物治疗问题；实现治疗目标的患者百分比以及达到高血压和高胆固醇血症HEDIS指标的情况。在患者加入MTM服务前后的1年时间内，测量每人的总医疗支出。
285名干预组患者共解决了637个药物治疗问题，实现治疗目标的患者百分比从76%提高到了90%。与对照组相比，干预组在高血压（71%对59%）和胆固醇管理（52%对30%）方面的HEDIS指标有所改善。每人的总医疗支出从11,965美元降至8,197美元（n = 186，P < 0.0001）。年度总医疗支出的减少幅度超过提供MTM服务成本的12倍以上。
接受药剂师与开处方者合作提供的面对面MTM服务的患者，临床结局得到改善，总医疗支出降低。MTM服务的临床结局对慢性病护理改善和基于价值的采购具有影响，经济结局支持将MTM服务纳入健康计划设计。
