Department of Health Policy and Management, Sol Price School of Public Policy, University of Southern California, Los Angeles.
Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles.
JAMA Netw Open. 2024 May 1;7(5):e2412998. doi: 10.1001/jamanetworkopen.2024.12998.
Integration of pharmacies with physician practices, also known as medically integrated dispensing, is increasing in oncology. However, little is known about how this integration affects drug use, expenditures, medication adherence, or time to treatment initiation.
To examine the association of physician-pharmacy integration with oral oncology drug expenditures, use, and patient-centered measures.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used claims data from a large commercial insurer in the US to analyze changes in outcome measures among patients treated by pharmacy-integrating vs nonintegrating community oncologists in 14 states between January 1, 2011, and December 31, 2019. Commercially insured patients were aged 18 to 64 years with 1 of the following advanced-stage diagnoses: breast cancer, colorectal cancer, kidney cancer, lung cancer, melanoma, or prostate cancer. Data analysis was conducted from May 2023 to March 2024.
Treatment by a pharmacy-integrating oncologist, ascertained by the presence of an on-site pharmacy or nonpharmacy dispensing site.
Oral, intravenous (IV), total, and out-of-pocket drug expenditures for a 6-month episode of care; share of patients prescribed oral drugs; days' supply of oral drugs; medication adherence measured by proportion of days covered; and time to treatment initiation. The association between an oncologist's pharmacy integration and each outcome of interest was estimated using the difference-in-differences estimator.
Between 2012 and 2019, 3159 oncologists (745 females [27.1%], 2002 males [72.9%]) treated 23 968 patients (66.4% female; 53.4% aged 55-64 years). Of the 3159 oncologists, 578 (18.3%) worked in practices that integrated with pharmacies (with a low rate in 2011 of 0% and a high rate in 2019 of 31.5%). In the full sample (including all cancer sites), after physician-pharmacy integration, no significant changes were found in oral drug expenditures, IV drug expenditures, or total drug expenditures. There was, however, an increase in days' supply of oral drugs (5.96 days; 95% CI, 0.64-11.28 days; P = .001). There were no significant changes in out-of-pocket expenditures, medication adherence, or time to treatment initiation of oral drugs. In the breast cancer sample, there was an increase in oral drug expenditures ($244; 95% CI, $41-$446; P = .02) and a decrease in IV drug expenditures (-$4187; 95% CI, -$8293 to -$80; P = .05).
Results of this cohort study indicated that the integration of oncology practices with pharmacies was not associated with significant changes in expenditures or clear patient-centered benefits.
药剂科与医师执业相结合，也称为医学整合配药，在肿瘤学中越来越普遍。然而，人们对这种整合如何影响药物使用、支出、药物依从性或治疗开始时间知之甚少。
研究医师-药剂师整合与口服肿瘤药物支出、使用和以患者为中心的措施之间的关系。
设计、地点和参与者：这项队列研究使用了美国一家大型商业保险公司的索赔数据，分析了 2011 年 1 月 1 日至 2019 年 12 月 31 日期间，14 个州的整合与非整合社区肿瘤学家治疗的患者的结局测量值的变化。商业保险患者年龄在 18 至 64 岁之间，有以下 1 种晚期诊断之一：乳腺癌、结直肠癌、肾癌、肺癌、黑色素瘤或前列腺癌。数据分析于 2023 年 5 月至 2024 年 3 月进行。
由现场药房或非药房配药点存在确定的由整合药房的肿瘤学家治疗。
治疗 6 个月期间的口服、静脉（IV）、总药物支出和自付药物支出；开具口服药物的患者比例；口服药物的供应天数；通过覆盖天数比例衡量的药物依从性；以及治疗开始时间。使用差异中的差异估计器估计了肿瘤学家的药房整合与每个感兴趣的结果之间的关联。
2012 年至 2019 年间，3159 名肿瘤学家（745 名女性[27.1%]，2002 名男性[72.9%]）治疗了 23968 名患者（66.4%为女性；53.4%为 55-64 岁）。在 3159 名肿瘤学家中，578 名（18.3%）在与药房整合的实践中工作（2011 年的低利率为 0%，2019 年的高利率为 31.5%）。在全样本（包括所有癌症部位）中，在医生-药房整合后，口服药物支出、IV 药物支出或总药物支出均无显著变化。然而，口服药物供应天数增加了（5.96 天；95%CI，0.64-11.28 天；P = .001）。自付支出、药物依从性或口服药物治疗开始时间均无显著变化。在乳腺癌样本中，口服药物支出增加（244 美元；95%CI，41-446 美元；P = .02），IV 药物支出减少（-4187 美元；95%CI，-8293 至-80 美元；P = .05）。
这项队列研究的结果表明，肿瘤学实践与药房的整合与支出或明确的以患者为中心的收益没有显著变化相关。
