Franklin Brandi E, Farland Michelle Z, Thomas Jeremy, McFarland M Shawn, Ray Shaunta' M, Byrd Debbie C
University of Tennessee Health Science Center College of Pharmacy, Memphis, TN, USA.
Ann Pharmacother. 2013 Dec;47(12):1627-34. doi: 10.1177/1060028013506883. Epub 2013 Oct 16.
Diabetes treatment cost increased 41% from 2007 to 2011. Pharmacists have provided collaborative diabetes management for decades with improvement in disease-related end points. Few have reported economic benefits of pharmacist management of type 2 diabetes.
The purpose was to determine if cost savings associated with hemoglobin A1c (A1C) and systolic blood pressure (SBP) change outweighed programmatic pharmacist-physician collaborative care model costs.
This cost analysis of a 12 month, prospective, multicenter, observational study included English-speaking adults, 18 years or older, with type 2 diabetes mellitus, a life expectancy >1 year, and either a A1C >7%, SBP >130 mm Hg, diastolic blood pressure >80 mm Hg, or low-density lipoprotein concentration >100 mg/dL. Pregnant patients were excluded. Primary analysis outcome was average cost per outcome, ratio of net cost (numerator) and percentage achieving outcomes (denominator). Assessment outcomes included A1C reduction by at least 1% and SBP reduction by at least 5.6 mm Hg.
206 patients were seen by pharmacists during 1612 encounters (mean = 7.8 encounters/patient). Pharmacists spent 983 hours caring for type 2 diabetes patients (mean 3.8 hours/patient). Base case net labor and program costs per patient were -$66.77 and $106.81, respectively. Improvement in A1C and SBP yielded $421.01 in cost savings per patient. Labor and program average costs per patient for each outcome achieved were -$100.40 and $160.61, respectively.
This multisite pharmacist-physician collaboration in diabetes management showed cost savings when assessing pharmacist labor costs alone. Total program costs, including overhead, slightly increased cost of care.
从2007年到2011年，糖尿病治疗成本增加了41%。几十年来，药剂师一直在提供糖尿病协作管理，疾病相关终点有所改善。很少有报告提及药剂师管理2型糖尿病的经济效益。
确定与糖化血红蛋白（A1C）和收缩压（SBP）变化相关的成本节约是否超过了药剂师 - 医生协作护理模式的项目成本。
这项为期12个月的前瞻性多中心观察性研究的成本分析纳入了18岁及以上、会说英语、患有2型糖尿病、预期寿命>1年且A1C>7%、SBP>130 mmHg、舒张压>80 mmHg或低密度脂蛋白浓度>100 mg/dL的成年人。排除孕妇。主要分析结果是每个结果的平均成本、净成本（分子）与达到结果的百分比（分母）之比。评估结果包括A1C至少降低1%和SBP至少降低5.6 mmHg。
药剂师在1612次会诊中诊治了206名患者（平均每位患者7.8次会诊）。药剂师花费983小时护理2型糖尿病患者（平均每位患者3.8小时）。基础病例每位患者的净劳动力和项目成本分别为 - 66.77美元和106.81美元。A1C和SBP的改善使每位患者节省成本421.01美元。实现每个结果时每位患者的劳动力和项目平均成本分别为 - 100.40美元和160.61美元。
在糖尿病管理中这种多地点的药剂师 - 医生合作，仅评估药剂师劳动力成本时显示出成本节约。包括管理费用在内的总项目成本使护理成本略有增加。
