School of Public Health, University of Alberta, Edmonton, Canada; Faculty of Pharmacy, Université Laval, Quebec City, Canada; and Population Health and Optimal Health Practices Research Unit, CHU de Québec, Université Laval Research Centre, Quebec City, Canada.
Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Canada.
J Manag Care Spec Pharm. 2021 Apr;27(4):426-434. doi: 10.18553/jmcp.2021.27.4.426.
The management of chronic diseases is a continuing challenge for health care systems and patients. To assess the effect of a pharmacist-specific chronic diseases management incentive plan (the Comprehensive Annual Care Plan [CACP]) implemented by the government of Alberta (Canada) on adherence to lipid-lowering drugs (LLD) among patients with hypertension. We conducted a cohort study of patients with hypertension who received the CACP between 2012 and 2015, using administrative health data. Patients who qualified to receive the CACP but did not receive it were selected as controls. Adherence was assessed 1 year before and after the CACP as the proportion of days covered (PDC) by any LLD. We conducted 2 distinct logistic regressions to assess the likelihood of an increase of the post-CACP PDC by 0.20 among patients with poor pre-CACP adherence (i.e., pre-CACP PDC < 0.80), and the post-CACP PDC decrease by 0.20 among those with previous good adherence. Data for 12,763 CACP patients and 14,555 controls were analysed. CACP patients who had a pre-CACP PDC < 0.80 were more likely to increase their PDC compared with controls (44.7% vs. 37.8%; adjusted odds ratio [aOR] = 1.34; 95% CI = 1.22-1.46). Conversely, CACP and control patients with a pre-CACP PDC ≥ 0.80 had similar likelihood to decrease their PDC (13.4% vs. 14.1%; aOR = 0.96; 95% CI = 0.88-1.04). The pharmacy CACP was associated with a modest improvement of adherence to LLD. The incentive system for improved care seemed more effective among patients who had low baseline adherence rates with minimal effect in those with previous good adherence. This work was supported by a grant from the Institute of Health Economics, with funding from Alberta Innovates and Eli Lilly Canada. The sponsor had no role in the study design, data acquisition, analysis, interpretation of the results, and the decision to publish. The authors have no conflicts of interest to disclose. This study is based on data provided by Alberta Health. The interpretation and conclusions contained herein are those of the researchers and do not necessarily represent the views of the government of Alberta nor the funder (Institute of Health Economics). Neither the government nor Alberta Health nor the Institute of Health Economics express any opinion in relation to this study.
慢性病管理是医疗保健系统和患者面临的持续挑战。本研究旨在评估艾伯塔省政府（加拿大）实施的药剂师特定慢性病管理激励计划（全面年度护理计划[CACP]）对高血压患者使用降脂药物（LLD）依从性的影响。我们对 2012 年至 2015 年间接受 CACP 的高血压患者进行了队列研究，使用了行政健康数据。选择符合接受 CACP 但未接受 CACP 的患者作为对照。使用任何 LLD 的覆盖率（PDC）来评估 CACP 前后 1 年的依从性。我们进行了 2 项独立的逻辑回归分析，以评估在 CACP 后，依从性较差的患者（即 CACP 前 PDC < 0.80）的 PDC 增加 0.20 的可能性，以及之前依从性较好的患者的 PDC 减少 0.20 的可能性。分析了 12763 名 CACP 患者和 14555 名对照者的数据。与对照组相比，CACP 患者的 CACP 前 PDC < 0.80 更有可能增加其 PDC（44.7% vs. 37.8%；调整后的优势比[aOR] = 1.34；95%CI = 1.22-1.46）。相反，CACP 和对照组患者的 CACP 前 PDC ≥ 0.80 降低 PDC 的可能性相似（13.4% vs. 14.1%；aOR = 0.96；95%CI = 0.88-1.04）。药房 CACP 与 LLD 依从性的适度改善相关。在基线依从率较低的患者中，改善护理的激励系统似乎更有效，而在之前依从性较好的患者中，效果较小。本工作得到艾伯塔省卫生研究院的资助，由艾伯塔省创新和礼来加拿大提供资金。赞助商在研究设计、数据收集、分析、结果解释和发表决定方面没有任何作用。作者没有利益冲突需要披露。本研究基于艾伯塔省卫生提供的数据。本文的解释和结论是研究人员的观点，不一定代表艾伯塔省政府或资助者（卫生经济研究所）的观点。政府、艾伯塔省卫生厅和卫生经济研究所均不对本研究发表任何意见。
