新加坡药剂师管理的危险因素管理诊所的长期临床和成本结果：一项观察性研究。
Long-term Clinical and Cost Outcomes of a Pharmacist-managed Risk Factor Management Clinic in Singapore: An Observational Study.
机构信息
Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore.
Department of Pharmacy, Tan Tock Seng Hospital, Singapore.
出版信息
Clin Ther. 2017 Dec;39(12):2355-2365. doi: 10.1016/j.clinthera.2017.10.009. Epub 2017 Nov 1.
PURPOSE
Few studies have determined the benefits of pharmacist-run clinics within a tertiary institution, and specifically on their capability to improve clinical outcomes as well as reduce the cost of illness. This study was designed to investigate the effectiveness of a pharmacist-managed risk factor management clinic (RFMP) in an acute care setting through the comparison of clinical (improvement in glycosylated hemoglobin level) and cost outcomes with patients receiving usual care.
METHODS
This single-center, observational study included patients aged ≥21 years old and diagnosed with type 2 diabetes mellitus (DM) who received care within the cardiology department of a tertiary institution between January 1, 2014, and December 31, 2015. The intervention group comprised patients who attended the RFMP for 3 to 6 months, and the usual-care group comprised patients who received standard cardiologist care. Univariate analysis and multiple linear regression were conducted to analyze the clinical and cost outcomes.
FINDINGS
A total of 142 patients with DM (71 patients in the intervention group and 71 patients in the usual-care group) with similar baseline characteristics were included. After adjusting for differences in baseline systolic blood pressure and triglyceride levels, the mean reduction in glycosylated hemoglobin level at 6 months from baseline in the intervention group was significantly lower by 0.78% compared with the usual-care group. Patients in the usual-care group had a significantly higher risk of hospital admissions within the 12 months from baseline compared with the intervention group (odds ratio, 3.84 [95% CI, 1.17-12.57]; P = 0.026). Significantly lower mean annual direct medical costs were also observed in the intervention group (US $8667.03 [$17,416.20] vs US $56,665.02 [$127,250.10]; P = 0.001).
IMPLICATIONS
The pharmacist-managed RFMP exhibited improved clinical outcomes and reduced health care costs compared with usual care within a tertiary institute.
目的
很少有研究确定了在三级医疗机构中由药剂师管理的诊所的益处，特别是在改善临床结果和降低疾病成本方面的能力。本研究旨在通过比较接受常规护理的患者的临床（糖化血红蛋白水平的改善）和成本结果，来调查在急性护理环境中由药剂师管理的风险因素管理诊所（RFMP）的效果。
方法
这是一项单中心观察性研究，纳入了 2014 年 1 月 1 日至 2015 年 12 月 31 日期间在三级机构心内科接受治疗的年龄≥21 岁且被诊断患有 2 型糖尿病（DM）的患者。干预组由参加 RFMP 治疗 3 至 6 个月的患者组成，常规护理组由接受标准心脏病专家护理的患者组成。进行单变量分析和多元线性回归分析以分析临床和成本结果。
结果
共纳入了 142 名患有 DM（干预组 71 名患者，常规护理组 71 名患者）且基线特征相似的患者。在校正基线收缩压和甘油三酯水平的差异后，干预组在 6 个月时糖化血红蛋白水平较基线的平均降低幅度显著低 0.78%，而常规护理组则显著高于干预组。与干预组相比，常规护理组在从基线开始的 12 个月内住院的风险显著更高（优势比，3.84[95%CI，1.17-12.57]；P=0.026）。干预组的年度直接医疗费用也显著降低（US$8667.03[17416.20] vs US$56665.02[127250.10]；P=0.001）。
结论
与三级机构的常规护理相比，药剂师管理的 RFMP 表现出改善的临床结果和降低的医疗保健成本。
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