Feehan M, Walsh M, Godin J, Sundwall D, Munger M A
Department of Pharmacotherapy, University of Utah, Salt Lake City, UT, USA.
Kantar Millward Brown Inc., New York, NY, USA.
J Clin Pharm Ther. 2017 Dec;42(6):738-749. doi: 10.1111/jcpt.12574. Epub 2017 Jun 18.
In order to improve public health, it is necessary to facilitate patients' easy access to affordable high-quality primary health care, and one enhanced approach to do so may be to provide primary healthcare services in the community pharmacy setting. Discrete choice experiments to evaluate patient demand for services in pharmacy are relatively limited and have been hampered by a focus on only a few service alternatives, most focusing on changes in more traditional pharmacy services. The study aim was to gauge patient preferences explicitly for primary healthcare services that could be delivered through community pharmacy settings in the USA, using a very large sample to accommodate multiple service delivery options.
An online survey was administered to a total of 9202 adult patients from the general population. A subsequent online survey was administered to 50 payer reimbursement decision-makers. The patient survey included a discrete choice experiment (DCE) which showed competing scenarios describing primary care service offerings. The respondents chose which scenario would be most likely to induce them to switch from their current pharmacy, and an optimal patient primary care service model was derived. The likelihood this model would be reimbursed was then determined in the payer survey.
The final optimal service configuration that would maximize patient preference included the pharmacy: offering appointments to see a healthcare provider in the pharmacy, having access to their full medical record, provide point-of-care diagnostic testing, offer health preventive screening, provide limited physical examinations such as measuring vital signs, and drug prescribing in the pharmacy. The optimal model had the pharmacist as the provider; however, little change in demand was evident if the provider was a nurse-practitioner or physician's assistant. The demand for this optimal model was 2-fold higher (25.5%; 95% Bayesian precision interval (BPI) 23.5%-27.0%) than for a base pharmacy offering minimal primary care services (12.6%; 95% BPI 12.2%-13.2%), and was highest among Hispanic (30.6%; 95% BPI: 25.7%-34.3%) and African American patients (30.7%; 95% BPI: 27.1%-35.2%). In the second reimbursement decision-maker survey, the majority (66%) indicated their organization would be likely to reimburse the services described in the optimal patient model if provided in the pharmacy setting.
This United States national study provides empirical support for a model of providing primary care services through community pharmacy settings that would increase access, with the potential to improve the public health.
为改善公众健康，有必要让患者更便捷地获得负担得起的高质量初级医疗保健服务，而一种强化途径可能是在社区药房提供初级医疗保健服务。评估患者对药房服务需求的离散选择实验相对有限，且因仅关注少数服务选项而受阻，大多数研究聚焦于更传统药房服务的变化。本研究旨在利用大量样本以涵盖多种服务提供选项，明确衡量美国患者对可通过社区药房提供的初级医疗保健服务的偏好。
对来自普通人群的9202名成年患者进行了在线调查。随后对50名支付方报销决策者进行了在线调查。患者调查包括一个离散选择实验（DCE），该实验展示了描述初级保健服务提供情况的竞争场景。受访者选择最有可能促使他们更换当前药房的场景，并得出了最佳患者初级保健服务模型。然后在支付方调查中确定该模型获得报销的可能性。
能使患者偏好最大化的最终最佳服务配置包括药房：提供在药房内看医疗服务提供者的预约，可获取完整病历，提供即时护理诊断检测，提供健康预防筛查，进行有限的身体检查如测量生命体征，以及在药房开处方。最佳模型以药剂师作为服务提供者；然而，如果服务提供者是执业护士或医师助理，需求变化不大。对这种最佳模型的需求（25.5%；95%贝叶斯精确区间（BPI）23.5% - 27.0%）比对提供最少初级保健服务的基础药房的需求（12.6%；95% BPI 12.2% - 13.2%）高出两倍，在西班牙裔患者（30.6%；95% BPI：25.7% - 34.3%）和非裔美国患者（30.7%；95% BPI：27.1% - 35.2%）中需求最高。在第二项报销决策者调查中，大多数（66%）表示，如果在药房环境中提供，他们所在机构可能会报销最佳患者模型中描述的服务。
这项美国全国性研究为通过社区药房提供初级保健服务的模式提供了实证支持，该模式可增加可及性，具有改善公众健康的潜力。
