J Am Pharm Assoc (2003). 2023 Nov-Dec;63(6):1722-1730.e3. doi: 10.1016/j.japh.2023.08.014. Epub 2023 Aug 21.
Primary care pharmacists are uniquely positioned to improve care quality by intervening within care transitions in the postdischarge period. However, additional evidence is required to demonstrate that pharmacist-led interventions can reduce health care utilization in a cost-effective manner. The study's objective was to evaluate the clinical and economic effectiveness of a pharmacy-led transition of care (TOC) program within a primary care setting.
This cluster randomized trial was conducted between 2019 and 2021 and included three primary care practices. Eligible patients were ≥18 years of age and at high risk of readmission. The multifaceted pharmacy intervention included medication reconciliation, comprehensive medication review, and patient and provider follow-up. The primary composite endpoint included hospital readmissions and emergency department (ED) visits within 30 days of discharge. Differences in outcomes were modeled using a generalized estimated equations approach and outcomes were assumed to be distributed as a Poisson random variable. A cost-benefit analysis was embedded within the study and estimated economic outcomes from a provider group/health system perspective. Cost measures included: net benefit, benefit to cost ratio (BCR), and return on investment (ROI).
Of 300 eligible patients, 36 were in the intervention group and 264 in the control group. The intervention significantly reduced the primary composite outcome of all-cause readmissions and ED visits within 30 days (adjusted incidence rate ratio [aIRR], 0.54; 95% CI, 0.44-0.66; P < 0.001). There were significant reductions in both 30-day all-cause readmissions (aIRR, 0.64; 95% CI, 0.60-0.67; P < 0.001) and ED visits (aIRR, 0.25; 95% CI, 0.20, 0.31; P < 0.001) between groups. The net benefit of the intervention was $9,078, with a BCR of 2.11 and a ROI of 111%. Sensitivity analyses were robust to changes in economic inputs.
This care transition program had positive clinical and economic benefits, providing further support for the essential role pharmacists demonstrate in providing TOC services.
初级保健药剂师通过在出院后期间干预护理过渡，能够独特地改善护理质量。然而，需要更多的证据来证明药师主导的干预措施能够以具有成本效益的方式减少医疗保健的利用。本研究的目的是评估初级保健环境中以药房为导向的护理过渡（TOC）计划的临床和经济效果。
这项集群随机试验于 2019 年至 2021 年进行，包括三个初级保健实践。合格的患者年龄在 18 岁以上且有高再入院风险。多方面的药房干预措施包括药物重整、全面药物审查以及患者和提供者的随访。主要复合终点包括出院后 30 天内的住院再入院和急诊部（ED）就诊。使用广义估计方程方法对结果进行建模，并假设结果呈泊松随机变量分布。研究中嵌入了成本效益分析，并从提供者群体/医疗保健系统的角度估计经济结果。成本措施包括：净效益、效益成本比（BCR）和投资回报率（ROI）。
在 300 名合格患者中，有 36 名患者在干预组，264 名患者在对照组。干预组显著降低了 30 天内所有原因的再入院和 ED 就诊的主要复合结局（调整后的发病率比 [aIRR]，0.54；95%置信区间，0.44-0.66；P < 0.001）。两组之间 30 天内所有原因的再入院（aIRR，0.64；95%置信区间，0.60-0.67；P < 0.001）和 ED 就诊（aIRR，0.25；95%置信区间，0.20，0.31；P < 0.001）均有显著减少。干预的净效益为 9078 美元，BCR 为 2.11，ROI 为 111%。敏感性分析对经济投入的变化具有稳健性。
这个护理过渡计划具有积极的临床和经济效益，进一步证明了药剂师在提供 TOC 服务方面发挥的重要作用。
