Kari Heini, Äijö-Jensen Nelli, Kortejärvi Hanna, Ronkainen Jukka, Yliperttula Marjo, Laaksonen Raisa, Blom Marja
Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland; Research Unit, The Social Insurance Institution of Finland, Helsinki, Finland.
Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland.
Res Social Adm Pharm. 2022 Jun;18(6):3004-3012. doi: 10.1016/j.sapharm.2021.07.025. Epub 2021 Jul 30.
There is a need for effective and cost-effective interprofessional care models that support older people to maintain their quality of life (QoL) and physical performance to live longer independently in their own homes.
The objectives were to evaluate effectiveness, QoL and physical performance, and cost-utility of a people-centred care model (PCCM), including the contribution of clinically trained pharmacists, compared with that of usual care in primary care.
A randomised controlled trial (RCT) with a two-year follow-up was conducted. The participants were multimorbid community-living older people, aged ≥75 years. The intervention comprised an at-home patient interview, health review, pharmacist-led clinical medication review, an interprofessional team meeting, and nurse-led care coordination and health support. At the baseline and at the 1-year and 2-year follow-ups, QoL (SF-36, 36-Item Short-Form Health Survey) and physical performance (SPPB, Short Performance Physical Battery) were measured. Additionally, a physical dimension component summary in the SF-36 was calculated. The SF-36 data were transformed into SF-6D scores to calculate quality-adjusted life-years (QALYs). Healthcare resource use were collected and transformed into costs. A healthcare payer perspective was adopted. Incremental cost-effectiveness ratio (ICER) was calculated, and one-way sensitivity analysis was performed.
No statistically or clinically significant differences were observed between the usual care (n = 126) and intervention group (n = 151) patients in their QoL; at the 2-year follow-up the mean difference was -0.02, (95 % CI -0.07; 0.04,p = 0.56). While the mean difference between the groups in physical performance at the 2-year follow-up was -1.02, (-1.94;-0.10,p = 0.03), between the physical component summary scores it was -7.3, (-15.2; 0.6,p = 0.07). The ICER was -73 638€/QALY, hence, the developed PCCM dominated usual care, since it was more effective and less costly.
The cost-utility analysis showed that the PCCM including pharmacist-led medication review dominated usual care. However, it had no effect on QoL and the effect towards physical performance remained unclear.
需要有效且具有成本效益的跨专业护理模式，以支持老年人维持其生活质量（QoL）和身体机能，从而能够在自己家中更长久地独立生活。
目的是评估以患者为中心的护理模式（PCCM）的有效性、生活质量和身体机能，以及成本效益，包括临床培训药师的贡献，并与初级保健中的常规护理进行比较。
进行了一项为期两年随访的随机对照试验（RCT）。参与者为患有多种疾病的社区居住老年人，年龄≥75岁。干预措施包括在家中进行患者访谈、健康评估、由药师主导的临床用药审查、跨专业团队会议，以及由护士主导的护理协调和健康支持。在基线、1年和2年随访时，测量生活质量（SF-36，36项简短健康调查）和身体机能（SPPB，简短身体机能测试）。此外，计算SF-36中的身体维度分量表总分。将SF-36数据转换为SF-6D分数以计算质量调整生命年（QALYs）。收集医疗资源使用情况并将其转换为成本。采用医疗保健支付者的视角。计算增量成本效益比（ICER），并进行单向敏感性分析。
在生活质量方面，常规护理组（n = 126）和干预组（n = 151）患者之间未观察到统计学或临床显著差异；在2年随访时，平均差异为-0.02，（95%CI -0.07；0.04，p = 0.56）。虽然两组在2年随访时身体机能的平均差异为-1.02，（-1.94；-0.10，p = 0.03），但身体分量表总分之间的差异为-7.3，（-15.2；0.6，p = 0.07）。ICER为-73 638€/QALY，因此，所开发的PCCM优于常规护理，因为它更有效且成本更低。
成本效益分析表明，包括由药师主导的用药审查的PCCM优于常规护理。然而，它对生活质量没有影响，对身体机能的影响仍不明确。
