1 University of Washington School of Public Health, Seattle, Washington.
2 Group Health Research Institute, Seattle, Washington.
J Manag Care Spec Pharm. 2016 Aug;22(8):909-17. doi: 10.18553/jmcp.2016.22.8.909.
In 2003, Group Health implemented a pharmacy-based, systemwide outreach effort to increase the preventive use of statins and angiotensin-converting enzyme inhibitors in enrollees at risk for cardiovascular disease, including all enrollees with diabetes.
To estimate the associations between the use of statins and major vascular events and the total costs in 2006-2010 for enrollees with diabetes, using a pharmacy-based, systemwide outreach.
In a 14-year (1997-2010) longitudinal cohort study design, the study population consisted of 6,975 Group Health enrollees with type 1 or type 2 diabetes, who were enrolled continuously and had no statin use before the Group Health outreach in 1997-2002. Health outcomes were all-cause mortality, cardiovascular mortality, myocardial infarction, and stroke. Statin exposure was measured by cumulative statin use since 2003, weighted by the effect of the statin type and dose on the lowering of low-density lipoprotein levels. Regression models estimated associations between cumulative statin use, health outcomes, and total costs in 2006-2010.
Among enrollees with no statin use before outreach began in 2003, about half had no or low exposure to statins by the end of 2005. In 2006-2010, cumulative statin use was greater among enrollees with risk factors for cardiovascular disease. Greater statin use was related to lower cardiovascular deaths and incidence of stroke and myocardial infarction, greater but nonsignificant all-cause mortality, and unrelated to total costs.
Population-based pharmacy outreach increased statin use for eligible enrollees with diabetes, which was related to better cardiovascular outcomes. Generally, statin use was unrelated to all-cause mortality and total costs.
This study was funded by Grant No. R21 HS019501 from the Agency for Healthcare Research and Quality (AHRQ) and was conducted as part of the AHRQ announcement Optimizing Prevention and Healthcare Management for the Complex Patient (R21; RFA-HS-10-009). Ralston and Anderson are employees of Group Health and the Group Health Research Institute, which provided the data for this study. Study concept and design were contributed by Grembowski, Ralston, and Anderson. Anderson assisted with data collection and analysis, and data interpretation was performed by Anderson, along with Grembowski and Ralston. The manuscript was prepared by Grembowski, along with Ralston and Anderson.
2003 年，Group Health 实施了一项以药房为基础、全系统的外展活动，旨在增加心血管疾病高危人群（包括所有糖尿病患者）中他汀类药物和血管紧张素转换酶抑制剂的预防性使用。
使用基于药房的全系统外展，估计在有糖尿病的患者中，2006-2010 年使用他汀类药物与主要血管事件和总费用之间的关联。
在一项 14 年（1997-2010 年）的纵向队列研究设计中，研究人群包括 6975 名患有 1 型或 2 型糖尿病的 Group Health 参保者，他们连续参保且在 1997-2002 年 Group Health 外展之前没有使用过他汀类药物。健康结果是全因死亡率、心血管死亡率、心肌梗死和中风。他汀类药物的暴露程度通过自 2003 年以来的累计他汀类药物使用情况来衡量，加权因素为他汀类药物类型和剂量对降低低密度脂蛋白水平的影响。回归模型估计了 2006-2010 年期间累积他汀类药物使用、健康结果和总费用之间的关联。
在 2003 年外展开始之前没有使用他汀类药物的参保者中，大约一半人在 2005 年底前没有或很少使用他汀类药物。在 2006-2010 年期间，心血管疾病高危人群的他汀类药物累积使用量更大。他汀类药物使用量的增加与心血管死亡和中风及心肌梗死发生率的降低有关，与全因死亡率的增加但无统计学意义有关，与总费用无关。
基于人群的药房外展增加了符合条件的糖尿病参保者使用他汀类药物的机会，这与改善心血管结局有关。一般来说，他汀类药物的使用与全因死亡率和总费用无关。
这项研究由美国医疗保健研究与质量局（AHRQ）的 R21 HS019501 号拨款资助，是 AHRQ 发布的优化复杂患者的预防和医疗管理（R21；RFA-HS-10-009）公告的一部分。Ralston 和 Anderson 是 Group Health 和 Group Health Research Institute 的员工，该研究所提供了这项研究的数据。Grembowski、Ralston 和 Anderson 提出了研究概念和设计。Anderson 协助了数据收集和分析，数据解释由 Anderson 与 Grembowski 和 Ralston 共同进行。Grembowski 与 Ralston 和 Anderson 共同撰写了手稿。
