School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich, UK.
Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK.
Res Social Adm Pharm. 2019 Jan;15(1):84-92. doi: 10.1016/j.sapharm.2018.03.062. Epub 2018 Mar 23.
The UK Community Pharmacy Future group developed the Pharmacy Care Plan (PCP) service with a focus on patient activation, goal setting and therapy management.
To estimate the effectiveness and cost-effectiveness of the PCP service from a health services perspective.
Patients over 50 years of age prescribed one or more medicines including at least one for cardiovascular disease or diabetes were eligible. Medication review and person-centred consultation resulted in agreed health goals and actions towards achieving them. Clinical, process and cost-effectiveness data were collected at baseline and 12-months between February 2015 and June 2016. Mean differences are reported for clinical and process measures. Costs (NHS) and quality-adjusted life year scores were estimated and compared for 12 months pre- and post-baseline.
Seven hundred patients attended the initial consultation and 54% had a complete set of data obtained. There was a significant improvement in patient activation score (mean difference 5.39; 95% CI 3.9-6.9; p < 0.001), systolic (mean difference -2.90 mmHg; 95% CI -4.7 to -1; p = 0.002) and diastolic blood pressure (mean difference -1.81 mmHg; 95% CI -2.8 to -0.8; p < 0.001), adherence (mean difference 0.26; 95% CI 0.1-0.4; p < 0.001) and quality of life (mean difference 0.029; 95% CI 0.015-0.044; p < 0.001). HDL cholesterol reduced significantly and QRisk2 scores increased significantly over the course of the 12 months. The mean incremental cost associated with the intervention was estimated to be £202.91 (95% CI 58.26 to £346.41) and the incremental QALY gain was 0.024 (95% CI 0.014 to 0.034), giving an incremental cost per QALY of £8495.
Enrolment in the PCP service was generally associated with an improvement over 12 months in key clinical and process metrics. Results also suggest that the service would be cost-effective to the health system even when using worst case assumptions.
英国社区药剂师未来组织开发了药剂师护理计划（PCP）服务，其重点在于患者激活、目标设定和治疗管理。
从卫生服务的角度评估 PCP 服务的有效性和成本效益。
符合条件的患者年龄在 50 岁以上，开有一种或多种药物，包括至少一种心血管疾病或糖尿病药物。药物审查和以人为本的咨询会产生共同的健康目标和实现这些目标的行动。2015 年 2 月至 2016 年 6 月期间，收集临床、过程和成本效益数据，在基线和 12 个月时进行比较。报告临床和过程措施的平均值差异。在基线前和后 12 个月，估计和比较 NHS 成本和质量调整生命年得分。
700 名患者参加了首次咨询，其中 54%获得了完整的数据集。患者激活评分（平均差异 5.39；95%CI 3.9-6.9；p<0.001）、收缩压（平均差异-2.90mmHg；95%CI -4.7 至 -1；p=0.002）和舒张压（平均差异-1.81mmHg；95%CI -2.8 至 -0.8；p<0.001）、用药依从性（平均差异 0.26；95%CI 0.1-0.4；p<0.001）和生活质量（平均差异 0.029；95%CI 0.015-0.044；p<0.001）均有显著改善。HDL 胆固醇显著降低，QRisk2 评分在 12 个月内显著增加。干预相关的平均增量成本估计为 202.91 英镑（95%CI 58.26 至 346.41 英镑），增量 QALY 增益为 0.024（95%CI 0.014 至 0.034），增量每 QALY 的成本为 8495 英镑。
参加 PCP 服务一般与 12 个月内关键临床和过程指标的改善相关。结果还表明，即使使用最坏情况假设，该服务对卫生系统也是具有成本效益的。
