J Am Pharm Assoc (2003). 2022 Mar-Apr;62(2):559-563. doi: 10.1016/j.japh.2021.10.030. Epub 2021 Oct 30.
Medicare is required to fully cover annual wellness visits (AWVs) to increase access to preventive care. As health care converts to pay for performance models, clinical quality measures have increasing importance. Few studies have investigated the effect of pharmacist-delivered AWVs on clinical quality measure attainment in a rural family medicine (FM) clinic setting.
The primary objective of this study was to evaluate attainment of clinical quality measures for pharmacist-delivered AWVs compared with physician-delivered AWVs (usual care). Secondary objectives included assessment of the number and type of drug therapy problems (DTPs) identified by pharmacists during AWVs.
This single-center retrospective cohort study was conducted within an FM clinic located in southwest Georgia. Two cohorts were created according to the provider of AWVs during 2017: pharmacist or physician-usual care. Data on quality measure eligibility, attainment, and DTPs (for the pharmacist group only) were collected through electronic chart review. Descriptive statistics were used to characterize variables, and chi-square (or Fisher exact where appropriate) tests to compare the proportion of clinical quality measures attained between groups.
Among 334 delivered AWVs, pharmacists performed 68.6%. Approximately 62% of pharmacist and usual care visits were female with mean ages of 72 (SD +/- 9.1) and 62 (SD +/- 13.9) years, respectively. Pharmacist-delivered AWVs had statistically significant greater quality measure attainment in the following categories: advance care planning, osteoporosis cardiovascular screenings, and Tdap vaccinations compared with usual care (P < 0.05). Usual care had statistically significant greater quality measure attainment for diabetes screening. Seventy-five DTPs were identified in the pharmacist group, with the majority being related to adherence (39%).
Pharmacist-delivered AWVs had greater quality measure attainment in several areas than usual care. Furthermore, increased quality measure attainment may assist in meeting benchmarks set by payers to ensure ongoing reimbursement of these services.
医疗保险需要全面涵盖年度健康访视（AWV），以增加获得预防保健的机会。随着医疗保健向按绩效付费模式转变，临床质量指标的重要性日益增加。很少有研究调查药剂师提供的 AWV 对农村家庭医学（FM）诊所临床质量指标实现的影响。
本研究的主要目的是评估与医生提供的 AWV（常规护理）相比，药剂师提供的 AWV 对临床质量指标的实现情况。次要目标包括评估药剂师在 AWV 期间发现的药物治疗问题（DTP）的数量和类型。
这项单中心回顾性队列研究在佐治亚州西南部的一个 FM 诊所进行。根据 2017 年 AWV 的提供者，创建了两个队列：药剂师或医生常规护理。通过电子病历回顾收集质量指标合格、实现和 DTP（仅适用于药剂师组）的数据。使用描述性统计数据来描述变量，并使用卡方检验（或适当情况下的 Fisher 精确检验）比较组间获得的临床质量指标的比例。
在 334 次提供的 AWV 中，药剂师进行了 68.6%。大约 62%的药剂师和常规护理就诊是女性，平均年龄分别为 72（SD+/-9.1）岁和 62（SD+/-13.9）岁。与常规护理相比，药剂师提供的 AWV 在以下类别中具有统计学意义上更高的质量指标实现率：预先护理计划、骨质疏松症心血管筛查和 Tdap 疫苗接种（P < 0.05）。常规护理在糖尿病筛查方面的质量指标实现率具有统计学意义。在药剂师组中发现了 75 个 DTP，其中大多数与依从性有关（39%）。
与常规护理相比，药剂师提供的 AWV 在多个领域实现了更高的质量指标。此外，提高质量指标的实现率可能有助于满足支付者设定的基准，以确保这些服务的持续报销。
