College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA.
J Am Pharm Assoc (2003). 2010 May-Jun;50(3):384-7. doi: 10.1331/JAPhA.2010.09058.
To evaluate the impact of implementing cost-control measures on drug use and financial performance of a student-run safety net clinic and to assess the effect of the measures on patient care.
Medication histories and patient information were obtained from the University of Nebraska Medical Center's student-run safety net clinics' (SHARING and GOODLIFE) computer databases and internal medication cost documents for all patients treated with medications at the clinics from April 1, 2006, through March 31, 2008. Main outcome measures were cost, use, and source of all medications and the resultant financial savings between the pre- and post-periods.
200 patients were treated with medications during the 2-year period (164 patients before April 1, 2007, and 137 after). A majority of clinic patients were treated for chronic conditions, including 62% for hypertension, 54% for diabetes, 46% for dyslipidemia, and 26% for depression. The average monthly cost to the clinics for medications decreased from $5,444.87 before April 1, 2007, to $3,714.05 (P = 0.002) after. With these changes, the cost per prescription from any delivery method decreased from $15.28 to $13.02 (P < 0.001) and the average cost per prescription decreased from $27.32 to $20.27 (P < 0.001) after formulary implementation. The number of prescriptions per patient per month was unchanged.
Medication management with a closed formulary in a diverse uninsured population reduced expenditures, with the largest savings coming from using prescriptions more efficiently while also providing a similar level of medical care.
评估在学生经营的平价医疗诊所实施成本控制措施对药物使用和财务绩效的影响，并评估这些措施对患者护理的影响。
从内布拉斯加大学医学中心学生经营的平价医疗诊所（SHARING 和 GOODLIFE）的计算机数据库和诊所所有患者的药物内部用药成本文件中获取 2006 年 4 月 1 日至 2008 年 3 月 31 日期间使用药物治疗的所有患者的用药记录和患者信息。主要结果测量指标是所有药物的成本、使用情况和来源，以及前后两个时期的财务节省。
在 2 年期间内，有 200 名患者接受了药物治疗（2007 年 4 月 1 日之前为 164 名，之后为 137 名）。诊所的大多数患者接受了慢性病治疗，包括 62%的高血压患者、54%的糖尿病患者、46%的血脂异常患者和 26%的抑郁症患者。诊所每月药物费用从 2007 年 4 月 1 日之前的 5444.87 美元降至实施处方集后的 3714.05 美元（P = 0.002）。通过这些变化，任何给药方式的每张处方成本从 15.28 美元降至 13.02 美元（P < 0.001），每张处方的平均成本从 27.32 美元降至 20.27 美元（P < 0.001）。患者每月的处方数量保持不变。
在多样化的无保险人群中，通过使用封闭式处方集进行药物管理可降低支出，最大的节省来自更有效地使用处方，同时提供类似水平的医疗服务。
