Bootman J L, Harrison D L, Cox E
Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, USA.
Arch Intern Med. 1997 Oct 13;157(18):2089-96.
Preventable drug-related morbidity and mortality within nursing facilities represent a serious problem urgently requiring expert medical attention. The health care costs of drug-related problems can be both immense and avoidable. However, the research to date has been narrow in scope, focusing on the drug costs avoided and failing to consider the wider range of possible negative outcomes and potential drug-related problems.
To develop a model of therapeutic outcomes resulting from drug therapy within nursing facilities, to estimate the magnitude of the cost of drug-related morbidity and mortality within nursing facilities in the United States, and to assess the impact of pharmacist-conducted, federally mandated, monthly, retrospective review of nursing facility residents' drug regimens in reducing the cost of drug-related morbidity and mortality.
Using decision analysis techniques, a probability pathway model was developed to estimate the cost of drug-related problems within nursing facilities. An expert panel consisting of consultant pharmacists and physicians with practice experience in nursing facilities and geriatric care was surveyed to determine conditional probabilities of therapeutic outcomes attributable to drug therapy. Health care utilization and associated costs derived from negative therapeutic outcomes were estimated.
Baseline estimates indicate that the cost of drug-related morbidity and mortality with the services of consultant pharmacists was $4 billion compared with $7.6 billion without the services of consultant pharmacists.
Drug-related morbidity and mortality in nursing facilities represent a serious economic problem. For every dollar spent on drugs in nursing facilities, $1.33 in health care resources are consumed in the treatment of drug-related problems. With the current federally mandated drug regimen review, it is estimated that consultant pharmacists help to reduce health care resources attributed to drug-related problems in nursing facilities by $3.6 million.
护理机构内可预防的药物相关发病率和死亡率是一个严重问题，迫切需要专家医疗关注。药物相关问题的医疗保健成本可能巨大且可避免。然而，迄今为止的研究范围狭窄，侧重于避免的药物成本，而未考虑更广泛的可能负面结果和潜在的药物相关问题。
建立护理机构内药物治疗产生的治疗结果模型，估计美国护理机构内药物相关发病率和死亡率的成本规模，并评估药剂师进行的、联邦政府强制要求的每月一次的护理机构居民药物治疗方案回顾在降低药物相关发病率和死亡率成本方面的影响。
使用决策分析技术，开发了一个概率路径模型来估计护理机构内药物相关问题的成本。对一个由在护理机构和老年护理方面有实践经验的顾问药剂师和医生组成的专家小组进行了调查，以确定药物治疗所致治疗结果的条件概率。估计了由负面治疗结果导致的医疗保健利用情况和相关成本。
基线估计表明，有顾问药剂师服务时药物相关发病率和死亡率的成本为40亿美元，而没有顾问药剂师服务时为76亿美元。
护理机构内药物相关发病率和死亡率是一个严重的经济问题。在护理机构中，每花费1美元用于药物，就有1.33美元的医疗保健资源用于治疗药物相关问题。据估计，如果进行当前联邦政府强制要求的药物治疗方案回顾，顾问药剂师可帮助将护理机构中因药物相关问题产生的医疗保健资源减少360万美元。
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