Clinical and Practice Research Group, School of Pharmacy and †Centre for Public Health, Queen's University Belfast, Belfast, UK.
J Am Geriatr Soc. 2011 Apr;59(4):586-93. doi: 10.1111/j.1532-5415.2011.03354.x. Epub 2011 Mar 31.
To evaluate the cost-effectiveness of an adapted U.S. model of pharmaceutical care to improve psychoactive prescribing for nursing home residents in Northern Ireland (Fleetwood NI Study).
Economic evaluation alongside a cluster randomized controlled trial.
Nursing homes in NI randomized to intervention (receipt of the adapted model of care; n=11) or control (usual care continued; n=11).
Residents aged 65 and older who provided informed consent (N=253; 128 intervention, 125 control) and who had full resource use data at 12 months.
Trained pharmacists reviewed intervention home residents' clinical and prescribing information for 12 months, applied an algorithm that guided them in assessing the appropriateness of psychoactive medication, and worked with prescribers (general practitioners) to make changes. The control homes received usual care in which there was no pharmacist intervention.
The proportion of residents prescribed one or more inappropriate psychoactive medications (according to standardized protocols), costs, and a cost-effectiveness acceptability curve. The latter two outcomes are the focus for this article.
The proportions of residents receiving inappropriate psychoactive medication at 12 months in the intervention and control group were 19.5% and 50.4%, respectively. The mean cost of healthcare resources used per resident per year was $4,923 (95% confidence interval (CI)=$4,206-5,640) for the intervention group and $5,053 (95% CI=$4,328-5,779) for the control group. The probability of the intervention being cost-effective was high, even at low levels of willingness to pay to avoid a resident receiving inappropriately prescribed psychoactive medication.
The Fleetwood NI model of care was more cost-effective than usual care.
评估经美国模式改良的药物治疗方案在改善北爱尔兰（弗利特伍德 NI 研究）养老院居民精神活性药物处方的成本效益。
伴随群组随机对照试验的经济评估。
NI 养老院随机分为干预组（接受改良药物治疗模式；n=11）或对照组（继续常规护理；n=11）。
年龄在 65 岁及以上，且知情同意（N=253；干预组 128 人，对照组 125 人），且在 12 个月时具有完整资源使用数据的居民。
经过培训的药剂师对干预组居民的临床和处方信息进行了 12 个月的审查，应用一种算法来评估精神活性药物的适宜性，并与处方医生（全科医生）合作进行更改。对照组养老院的常规护理中没有药剂师干预。
接受一种或多种不适当精神活性药物治疗的居民比例（根据标准化方案）、成本和成本效益可接受性曲线。后两个结果是本文的重点。
干预组和对照组在 12 个月时接受不适当精神活性药物治疗的居民比例分别为 19.5%和 50.4%。干预组每位居民每年的医疗资源使用总成本为 4923 美元（95%置信区间（CI）=4206-5640），对照组为 5053 美元（95% CI=4328-5779）。即使在对避免居民接受不适当处方精神活性药物的支付意愿较低的情况下，干预措施也具有较高的成本效益。
弗利特伍德 NI 护理模式比常规护理更具成本效益。
