Deal Heidi J, Cooke Charmaine A, Ingram Ethel M Langille, Sketris Ingrid S
1College of Pharmacy, Dalhousie University.
Investment and Decision Support, Nova Scotia Department of Health and Wellness.
J Popul Ther Clin Pharmacol. 2017 Feb 1;24(1):e46-e55. doi: 10.22374/17106222.24.1.6.
Pharmacists conduct medication reviews to optimize drug therapy. Each jurisdiction implements and funds these programs differently.
To describe the uptake of the first year of a community pharmacy medication review program reimbursed by the publically insured seniors' drug benefit program in Nova Scotia, Canada.
This retrospective analysis included 294 pharmacies and 105,000 beneficiaries enrolled in the Nova Scotia Seniors' Pharmacare Program. Prescription and service claims data from this program were analyzed to determine type and number of beneficiaries receiving a medication review, number and predictors of pharmacies completing reviews, and number of prescribed medications 6-months before and 6-months after the review.
428 medication reviews were conducted and billed by 33% of Nova Scotia pharmacies (1-50 reviews per pharmacy per year). The mean number and range of medications before the review were 10.8 (4-28) and following the review 10.4 (0-24), with an average decrease of 0.4 medications (95% CI 0.1-0.6), p=.0043). Patients receiving a review had a mean age of 75.2 years; 64.9% were female. Most pharmacies conducted reviews when patients reached their annual copayment (93%).
Approximately 33% of pharmacies billed at least one medication review in the first year of the program. In spite of a $150 reimbursement per community pharmacy medication review, only 428 reviews were conducted over a 13-month period for a population of over 100,000 seniors. Results suggest financial reimbursement alone is not sufficient to implement a medication management program; health systems need to determine patient, pharmacist, pharmacy and health system level strategies to implement medication reviews more broadly.
药剂师开展药物评估以优化药物治疗。每个司法管辖区实施和资助这些项目的方式各不相同。
描述加拿大新斯科舍省由公共保险的老年人药物福利计划报销的社区药房药物评估项目第一年的实施情况。
这项回顾性分析纳入了新斯科舍省老年人药物护理计划中的294家药房和105,000名受益人。分析该项目的处方和服务报销数据，以确定接受药物评估的受益人的类型和数量、完成评估的药房数量及预测因素，以及评估前6个月和评估后6个月的处方药数量。
新斯科舍省33%的药房（每家药房每年进行1 - 50次评估）进行了428次药物评估并提交了报销申请。评估前的平均用药数量和范围为10.8（4 - 28）种，评估后的平均用药数量和范围为10.4（0 - 24）种，平均减少了0.4种药物（95%置信区间0.1 - 0.6），p = 0.0043）。接受评估的患者平均年龄为75.2岁；64.9%为女性。大多数药房在患者达到年度自付费用时进行评估（93%）。
在该项目的第一年，约33%的药房至少提交了一次药物评估的报销申请。尽管每次社区药房药物评估有150美元的报销费用，但在13个月的时间里，针对超过10万名老年人仅进行了428次评估。结果表明，仅靠经济报销不足以实施药物管理项目；卫生系统需要确定患者、药剂师、药房和卫生系统层面的策略，以更广泛地实施药物评估。
