Department of General Practice and the Amsterdam Public Health Research Institute, Amsterdam University Medical Center, VUmc Location, Amsterdam, The Netherlands.
Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, VUmc Location, Amsterdam, The Netherlands.
Int J Clin Pharm. 2019 Aug;41(4):963-971. doi: 10.1007/s11096-019-00825-3. Epub 2019 Jun 17.
Background Drug-related problems (DRP) following hospital discharge may cause morbidity, mortality and hospital re-admissions. It is unclear whether a clinical medication review (CMR) and counseling at discharge is a cost-effective method to reduce DRP. Objective To assess the effect of a CMR on health care utilization and to investigate whether CMR is a cost-effective method to reduce DRP in older polypharmacy patients discharged from hospital. Setting 24 community pharmacies in the Netherlands. Method A cluster-randomized controlled trial with an economic evaluation. Community pharmacies were randomized to those providing a CMR, counseling and follow-up at discharge and those providing usual care. Main outcome measures Change in the number of DRP after 1 year of follow-up and costs of health care utilization during follow-up. In 216 patients the use of health care was prospectively assessed. Missing data on effects and costs were imputed using multiple imputation techniques. Bootstrapping techniques were used to estimate the uncertainty around the differences in costs and incremental cost-effectiveness ratios. Results CMR resulted in a small reduction of DRP. The proportion of patients readmitted to the hospital during 6 months of follow-up was significantly higher in the intervention group than in the control group (46.4 vs. 20.9%; p < 0.05). Health care costs were higher in the intervention group, although not statistically significant. The costs of reducing one DRP by a CMR amounted to €8270. Conclusion A CMR in vulnerable older patients at hospital discharge led to a small reduction in DRP. Because of a significantly higher use of health care and higher number of re-hospitalisations post CMR, the present study data indicate that performing the intervention in this patient population is not cost-effective.
出院后与药物相关的问题（DRP）可能导致发病率、死亡率和医院再入院。目前尚不清楚在出院时进行临床药物审查（CMR）和咨询是否是降低 DRP 的一种具有成本效益的方法。目的：评估 CMR 对医疗保健利用的影响，并研究 CMR 是否是降低出院后老年多药患者 DRP 的一种具有成本效益的方法。设置：荷兰 24 家社区药房。方法：一项具有经济评估的集群随机对照试验。社区药房被随机分配到提供 CMR、咨询和出院后随访的药房和提供常规护理的药房。主要结局指标：随访 1 年后 DRP 的数量变化和随访期间医疗保健利用的成本。在 216 名患者中，前瞻性评估了医疗保健的使用情况。使用多重插补技术对效果和成本的缺失数据进行了插补。使用自举技术估计成本差异和增量成本效益比的不确定性。结果：CMR 导致 DRP 略有减少。在干预组中，在 6 个月的随访期间，再次住院的患者比例明显高于对照组（46.4%比 20.9%；p<0.05）。干预组的医疗保健成本较高，但无统计学意义。通过 CMR 减少一个 DRP 的成本为 8270 欧元。结论：在出院时对脆弱的老年患者进行 CMR 可导致 DRP 略有减少。由于干预后医疗保健的使用量明显增加且再次住院的人数增加，本研究数据表明，在该患者人群中进行干预不具有成本效益。
