Chongpornchai Jongkonnee, Phodha Tuangrat, Wongphan Thanawat, Soonklang Kamonwan, Coyte Peter C
Drug Information and Consumer Protection Center, Center of Excellence in Pharmacy Practice and Management Research, Faculty of Pharmacy, Thammasat University, Pathum Thani, Thailand.
Nakhon Nayok Provincial Public Health Office, Nakhon Nayok, Thailand.
J Pharm Policy Pract. 2025 Aug 27;18(1):2544644. doi: 10.1080/20523211.2025.2544644. eCollection 2025.
Management of non-communicable diseases (NCDs), including hypertension (HT) and diabetes mellitus (DM), was significantly impacted by the COVID-19 pandemic. Many institutions adopted alternative care pathways, e.g. pharmacy at home (PAH), and the deferred care (DC). While PAH has been studied for clinical outcomes, evaluation of the DC remains limited. Consequently, this study evaluates both the clinical and economic outcomes of the PAH and DC as alternatives to usual care.
A retrospective study was conducted at a tertiary care hospital in Thailand from 1 July 2021, to 30 June 2023. Data from outpatients with HT and DM were classified into PAH, DC, or discharged home with follow-up at the hospital. Clinical outcomes included changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), and fasting blood sugar (FBS), calculated from baseline to follow-up. Economic outcome was the cost of illness (COI) per patient visit. Multivariate multilevel mixed-effects linear regression assessed clinical outcomes, while log-linear regression evaluated economic outcome.
There were 3,518 patients in the pandemic period and 4,135 patients in the post pandemic period. There was no statistically significant impact of PAH and DC on changes in SBP, DBP, and FBS. However, both care pathways significantly reduced COI during both periods ( < 0.001). During the pandemic period, COI reductions were 32.3% in PAH and 93.5% in DC compared to usual care. Similar trends were observed in the post pandemic period, with COI reductions of 40.0% for PAH and 96.1% for DC.
PAH and DC pathways did not worsen the clinical outcomes and reduced costs during and following the pandemic. As a result, these two pathways, developed during the COVID-19 pandemic, can be adapted for regular use. When these pathways are integrated into regular use, they can be promptly and fully reactivated in future emergencies.
包括高血压（HT）和糖尿病（DM）在内的非传染性疾病（NCDs）的管理受到了2019冠状病毒病大流行的重大影响。许多机构采用了替代护理途径，例如居家药房（PAH）和延期护理（DC）。虽然已经对居家药房的临床结果进行了研究，但对延期护理的评估仍然有限。因此，本研究评估了居家药房和延期护理作为常规护理替代方案的临床和经济结果。
于2021年7月1日至2023年6月30日在泰国一家三级护理医院进行了一项回顾性研究。患有高血压和糖尿病的门诊患者的数据被分为居家药房组、延期护理组或出院回家并在医院进行随访组。临床结果包括从基线到随访期间收缩压（SBP）、舒张压（DBP）和空腹血糖（FBS）的变化。经济结果是每次患者就诊的疾病成本（COI）。多变量多层次混合效应线性回归评估临床结果，而对数线性回归评估经济结果。
大流行期间有3518名患者，大流行后时期有4135名患者。居家药房和延期护理对收缩压、舒张压和空腹血糖的变化没有统计学上的显著影响。然而，在两个时期，这两种护理途径均显著降低了疾病成本（<0.001）。在大流行期间，与常规护理相比，居家药房的疾病成本降低了32.3%，延期护理降低了93.5%。在大流行后时期也观察到了类似趋势，居家药房的疾病成本降低了40.0%，延期护理降低了96.1%。
居家药房和延期护理途径在大流行期间及之后并未使临床结果恶化，且降低了成本。因此，在2019冠状病毒病大流行期间开发的这两种途径可适用于常规使用。当这些途径被纳入常规使用时，它们可以在未来的紧急情况下迅速且全面地重新启用。
