Truong Hoai-An, Groves C Nicole, Congdon Heather B, Dang Diem-Thanh Tanya, Botchway Rosemary, Thomas Jennifer
J Am Pharm Assoc (2003). 2015 May-Jun;55(3):269-72. doi: 10.1331/JAPhA.2015.14062.
To evaluate potential cost savings based on estimated cost avoidance from medication therapy management (MTM) services delivered in safety-net clinics over 4 years.
High-risk patients taking multiple medications and with chronic conditions were referred for MTM services in primary care safety-net clinics in Maryland from October 1, 2009, to September 30, 2013. Medication-related problems (MRPs) were identified and pharmacists' costs determined to evaluate the estimated cost savings and return on investment (ROI). A range of potential economic outcomes for each MRP identified was assigned to a cost avoidance for outpatient visit, urgent care visit, emergency department visit, and/or hospitalization.
Over 4 years, 246 patients received MTM, nearly 2,100 medications were reviewed, and 814 MRPs were identified. The most common MRPs identified were subtherapeutic doses, nonadherence, and untreated indications, with respective prevalences of 38%, 19%, and 16%. The corresponding costs of medical services were estimated at $115,220-$614,570 for all MRPs identified, yielding a mean of $141.55-$755.00 per identified MRP. Pharmacists' expenses for encounters were calculated at a total expenditure of $57,307.50 for 16,965 minutes. ROI based on the time spent during billable face-to-face encounters ranged from 1:5 to 1:25.
Pharmacist-provided MTM in safety-net clinics yielded potential economic benefits to the organization. The Primary Care Coalition of Montgomery County plans to expand MTM services to additional clinics to improve patient care and increase cost savings through preventable medical services.
基于对安全网诊所提供的药物治疗管理（MTM）服务在4年期间避免的成本估计，评估潜在的成本节约情况。
2009年10月1日至2013年9月30日期间，马里兰州基层医疗安全网诊所将服用多种药物且患有慢性病的高危患者转介接受MTM服务。识别与药物相关的问题（MRP）并确定药剂师的成本，以评估估计的成本节约和投资回报率（ROI）。为每个识别出的MRP分配一系列潜在的经济结果，以确定门诊就诊、紧急护理就诊、急诊就诊和/或住院治疗避免的成本。
在4年期间，246名患者接受了MTM服务，审查了近2100种药物，识别出814个MRP。识别出的最常见MRP是治疗剂量不足、不依从和未治疗的适应症，其患病率分别为38%、19%和16%。所有识别出的MRP的相应医疗服务成本估计为115220美元至614570美元，每个识别出的MRP平均成本为141.55美元至755.00美元。药剂师会诊的费用计算得出，16965分钟的总支出为57307.50美元。基于可计费面对面会诊时间的投资回报率范围为1:5至1:25。
安全网诊所由药剂师提供的MTM服务为机构带来了潜在的经济效益。蒙哥马利县基层医疗联盟计划将MTM服务扩展到更多诊所，以改善患者护理并通过可预防的医疗服务增加成本节约。
