Economic outcomes of pharmacist-physician medication therapy management for polypharmacy elderly: A prospective, randomized, controlled trial

被引：45

作者：

Lin, Hsiang-Wen ^{[1
,2
,3
,4
]}

Lin, Chih-Hsueh ^{[5
]}

Chang, Chin-Kai ^{[6
]}

Chou, Che-Yi ^{[7
]}

Yu, I-Wen ^{[8
]}

Lin, Cheng-Chieh ^{[5
,9
]}

Li, Tsai-Chung ^{[10
]}

Li, Chia-Ing ^{[11
]}

Hsieh, Yow-Wen ^{[1
,2
,3
]}

机构：

[1] China Med Univ, Coll Pharm, Sch Pharm, 91 Hsueh Shih Rd, Taichung 40402, Taiwan

[2] China Med Univ, Coll Pharm, Grad Inst, 91 Hsueh Shih Rd, Taichung 40402, Taiwan

[3] China Med Univ Hosp, Dept Pharm, Taichung, Taiwan

[4] Univ Illinois, Coll Pharm, Dept Pharm Syst Outcomes & Policy, Chicago, IL USA

[5] China Med Univ Hosp, Dept Family Med, Taichung, Taiwan

[6] China Med Univ Hosp, Dept Rehabil, Taichung, Taiwan

[7] China Med Univ Hosp, Dept Internal Med, Taichung, Taiwan

[8] Supra Integrat & Incubat Ctr, Taipei, Taiwan

[9] China Med Univ, Coll Med, Sch Med, Taichung, Taiwan

[10] China Med Univ, Grad Inst Biostat, Taichung, Taiwan

[11] China Med Univ Hosp, Dept Med Res, Taichung, Taiwan

来源：

JOURNAL OF THE FORMOSAN MEDICAL ASSOCIATION | 2018年 / 117卷 / 03期

关键词：

Aged; Economics; Medical; Medication therapy management; Pharmacists; Polypharmacy; Taiwan; OLDER-ADULTS; CARE;

D O I：

10.1016/j.jfma.2017.04.017

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background/Purpose: With an increasing geriatric population, the need for effective management of chronic conditions and medication use in the elderly is growing. Medication use in the elderly presents significant challenges due to changes in pharmacodynamic and pharmacokinetic profiles. We aimed to examine the impact of a collaborative physician-pharmacist medication therapy management (MTM) program for polypharmacy elderly patients. Methods: Elderly patients with multiple chronic conditions on polypharmacy were enrolled in this prospective, randomized, and controlled study over 16 months of implementation. The intervention group consisted of patients randomized to a collaborative pharmacist-physician MTM program. They were monitored continuously by a clinical pharmacist, while patients in the control group received only usual care with follow-up assessment. Primary outcome was economic differences, measured in total medical expenditure. Secondary outcomes of clinical and humanistic effects were compared between the two groups. Results: The total number of enrolled patients was 87 and 91 in the MTM and usual groups, respectively. The difference-in-difference estimate on medical expenditure during the 16-month implementation period was $3,758,373 New Taiwan Dollars ($127,015 US Dollars) less than the usually care group. Impact was also seen in humanistic outcomes while lipid profiles and mortality trended toward improvement. Conclusion: The pharmacist- physician collaborative MTM program for polypharmacy elderly had significant cost savings and improvement in humanistic measures, demonstrating the importance of clinical pharmacists and MTM programs for elderly patients in Taiwan. The results suggest the possibility of clinical benefits, but the study was not substantially powered to find a statistical difference. Copyright (C) 2017, Formosan Medical Association. Published by Elsevier Taiwan LLC.

引用

页码：235 / 243

页数：9

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