King Cynthia A, King Benjamin S, Nagaraj Tara, Dave Gothard M
MetroHealth System, Cleveland OH.
BioStats Inc., East Canton OH.
Innov Pharm. 2024 Aug 21;15(3). doi: 10.24926/iip.v15i3.6300. eCollection 2024.
Ambulatory care pharmacists (ACPs) on healthcare teams improve patient outcomes and can manage multiple chronic disease states. ACPs have demonstrated clinical benefit but need to prove financial sustainability. The primary objective of this study was to determine the cost-effectiveness of utilizing ACPs for diabetes mellitus (DM) management. This was a quasi-experimental, retrospective, single health system, multi-clinic cohort study of 406 patients living with DM, ≥ 18 years of age, with a HbA1c of ≥ 8%, receiving primary care services within an academic health system between May 2015 to March 2018. In the ACP group, the ACP was part of the care team for DM management while in the PCP group, patients were managed only by a PCP with or without an endocrinologist (usual care). The incremental cost-effectiveness ratio (ICER) was calculated to determine the clinic-associated cost of an ACP-led DM management clinic. Based on the ICER calculation, clinic-associated cost for ACP-led DM management was $126 per patient per year for each additional HbA1c percent lowered. Additional ICER calculations demonstrated the clinic-associated cost to move one patient with HbA1c ≥9% to HbA1c < 9% was $612. Change in HbA1c over 12 months was -2.5% in the ACP group and in the PCP group +1.08% (p<0.001). Based on quality metrics at 12-months, the ACP group met the goal of 75% of patients having a HbA1c < 9% and being prescribed a statin vs. the PCP group only met the metric for statin use. Based on facility fee billing, the ACPs cover approximately 70% of their annual salary and benefits from face-to-face visits. ACPs led to significantly improved clinical outcomes with marginal up-front costs that could lead potential future cost savings through reductions in DM related complications or improving incentivized returns by achieving goal quality metric levels.
医疗团队中的门诊护理药剂师（ACPs）可改善患者治疗效果，并能管理多种慢性疾病状态。ACPs已显示出临床益处，但需要证明其财务可持续性。本研究的主要目的是确定利用ACPs进行糖尿病（DM）管理的成本效益。这是一项准实验性、回顾性、单健康系统、多诊所队列研究，研究对象为406例年龄≥18岁、HbA1c≥8%、于2015年5月至2018年3月在学术健康系统内接受初级保健服务的糖尿病患者。在ACPs组中，ACPs是糖尿病管理护理团队的一部分，而在初级保健医生（PCP）组中，患者仅由初级保健医生管理，有无内分泌科医生均可（常规护理）。计算增量成本效益比（ICER）以确定由ACPs主导的糖尿病管理诊所的临床相关成本。根据ICER计算，每降低1%的HbA1c，由ACPs主导的糖尿病管理的临床相关成本为每位患者每年126美元。额外的ICER计算表明，将一名HbA1c≥9%的患者转变为HbA1c<9%的临床相关成本为612美元。ACPs组12个月内HbA1c的变化为-2.5%，PCP组为+1.08%（p<0.001）。根据12个月时的质量指标，ACPs组达到了75%的患者HbA1c<9%并开具他汀类药物的目标，而PCP组仅达到了他汀类药物使用指标。根据机构费用计费，ACPs通过面对面就诊可覆盖其年薪和福利的约70%。ACPs带来了显著改善的临床结果，前期成本微不足道，通过减少糖尿病相关并发症或通过达到目标质量指标水平提高激励回报，可能会在未来节省成本。
