Fox David, Ried L Douglas, Klein Gary E, Myers Wendy, Foli Kristen
Florida Health Care Plans, Holly Hill, USA.
J Am Pharm Assoc (2003). 2009 Mar-Apr;49(2):192-9. doi: 10.1331/JAPhA.2009.09016.
To determine a medication therapy management (MTM) service's impact on (1) Healthcare Effectiveness Data and Information Set (HEDIS) quality measures and (2) use and cost expenditures.
Nonequivalent group, quasiexperimental study.
Florida, January 1, 2006, through September 30, 2007.
2,114 Florida Health Care Plans Medicare Part D enrollees with diabetes.
Intervention group participated in the MTM program during the HEDIS measurement year.
Presence of low-density lipoprotein cholesterol (LDL-C) screening, LDL-C values, and LDL-C control (<100 mg/dL). The use measure was the total number of 30-day medication equivalents. Cost measures were (1) total Medicare Part D drug cost, (2) enrollees' out-of-pocket Part D medication costs, and (3) total medication copayments. Statistical analyses included chi-square, independent and paired t tests, and analysis of variance with post hoc comparisons.
Of 2, 114 enrollees eligible for comprehensive diabetes care (CDC) according to HEDIS guidelines, 255 participated in the MTM intervention group and 56 patients were MTM eligible but opted out of the program or could not be reached for medication review during 2008 (MTM nonparticipants). A higher proportion of patients in the MTM participant group had LDL-C levels less than 100 mg/dL (69.0%) compared with those in the MTM nonparticipant (50.0%) and CDC only (54.1%) groups (chi2 = 20.9(3), P < 0.001). The two control groups' average LDL-C (90.8 and 93.6 mg/dL) was significantly higher than the intervention group (83.4 mg/dL, P < 0.001). Overall, per member per month use and drug costs differed from 2007 to 2008 and enrollees in the MTM participant group had greater percentage cost reductions.
Enrollees who were eligible for MTM services but did not receive them had poorer clinical, use, and cost outcomes compared with the MTM intervention group. Pharmacists collaborating with physicians through a MTM program can improve quality of metrics for chronic diseases and reduce medication costs.
确定药物治疗管理（MTM）服务对（1）医疗保健有效性数据和信息集（HEDIS）质量指标以及（2）使用情况和成本支出的影响。
非等效组、准实验研究。
佛罗里达州，2006年1月1日至2007年9月30日。
2114名佛罗里达医疗保健计划医疗保险D部分的糖尿病参保者。
干预组在HEDIS测量年度参加MTM项目。
低密度脂蛋白胆固醇（LDL-C）筛查情况、LDL-C值以及LDL-C控制情况（<100mg/dL）。使用指标为30天药物等效物总数。成本指标为：（1）医疗保险D部分药物总费用；（2）参保者D部分药物自付费用；（3）药物共付总额。统计分析包括卡方检验、独立样本和配对t检验以及方差分析和事后比较。
根据HEDIS指南，2114名符合综合糖尿病护理（CDC）条件的参保者中，255人参加了MTM干预组，56名患者符合MTM条件，但在2008年选择退出该项目或无法联系到进行药物审查（MTM未参与者）。MTM参与者组中LDL-C水平低于100mg/dL的患者比例（69.0%）高于MTM未参与者组（50.0%）和仅接受CDC组（54.1%）（χ²=20.9(3)，P<0.001）。两个对照组的平均LDL-C（90.8和93.6mg/dL）显著高于干预组（83.4mg/dL，P<0.001）。总体而言，2007年至2008年，每月每位成员的使用情况和药物成本有所不同，MTM参与者组的参保者成本降低百分比更大。
与MTM干预组相比，有资格获得MTM服务但未接受服务的参保者在临床、使用情况和成本结局方面较差。通过MTM项目与医生合作的药剂师可以提高慢性病指标的质量并降低药物成本。
