Cost–Utility Analysis of a Pharmacotherapy Follow‐Up for Elderly Nursing Home Residents in Spain

Jódar-Sánchez, Francisco; Martín, José Jesús Martín; Amo, M. Puerto López del; García, L.; Araújo-Santos, José M.; Epstein, David

doi:10.1111/jgs.12890

Cited by 18 publications

(27 citation statements)

References 31 publications

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“…In this study, we saw a drop in the number of drugs for both groups, although this tendency was greater among the older adults in the IG (0.28 drugs; p<0.001) than for those in the CG (0.07 drugs; p=0.063). In a recent study of a MRF service for nursing home residents in Spain [36], pharmacist interventions reduced the mean number of prescribed medications by 0.47 drugs (p<0.001), whereas the mean number of prescribed medications increased by 0.94 drugs in the CG (p<0.001). Participants were residents aged 65 or over, but their health state was worse than in the case of the participants in the present study, and this may explain why that intervention was more effective in optimizing prescribed medication.…”

Section: Discussionmentioning

confidence: 99%

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Cost-Utility Analysis of a Medication Review with Follow-Up Service for Older Adults with Polypharmacy in Community Pharmacies in Spain: The conSIGUE Program

et al. 2015

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BackgroundThe concept of Pharmaceutical Care is operationalized through pharmaceutical professional services, which are patient-oriented to optimize their pharmacotherapy and to improve clinical outcomes. ObjectiveThe objective of this study was to estimate the incremental cost-effectiveness ratio (ICER) of a medication review with follow-up (MRF) service for older adults with polypharmacy in Spanish community pharmacies, against the alternative of having their medication dispensed normally. MethodsThe study was designed as a cluster randomized controlled trial, and was carried out over a time horizon of six months. The target population was older adults with polypharmacy, defined as individuals taking five or more medicines per day. The study was conducted in 178 community pharmacies in Spain. Costutility analysis adopted a health service perspective. Costs were in euros at 2014 prices and the effectiveness of the intervention was estimated as QALYs. In order to analyze the uncertainty of ICER results, we performed a nonparametric bootstrapping with 5,000 replications. ConclusionMRF service is an effective intervention for optimizing prescribed medication and improving the quality of life in older adults with polypharmacy in community pharmacies. The results from the cost-utility analysis suggest that MRF service is cost effective. Key points for decision makers-Polypharmacy is a particular concern in older adult populations, and is associated with negative health outcomes.-Medication review with follow-up is a service that attempts to optimize pharmacotherapy, not just by focusing on the process of the use of medication, but also by improving clinical outcomes for older adults.-Medication review with follow-up service is an effective intervention for optimizing prescribed medication and improving the quality of life of older adults with polypharmacy in community pharmacies. Compared with usual dispensing, this service is cost effective.3

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Section: Discussionmentioning

confidence: 99%

“…Jódar-Sánchez et al [36] evaluated the cost-effectiveness of a MRF service for older adult residents in nursing homes in Spain, obtaining an adjusted ICER of €6,574/QALY (in the more realistic scenario).…”

Section: Discussionmentioning

confidence: 99%

Cost-Utility Analysis of a Medication Review with Follow-Up Service for Older Adults with Polypharmacy in Community Pharmacies in Spain: The conSIGUE Program

et al. 2015

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“…The majority of studies were located in the United States, UK and Australia with smaller numbers from the Netherlands, Canada and Belgium . Twelve papers reported randomised controlled trials, and five were non‐randomised controlled studies, with the remainder pre‐/post‐uncontrolled interventions conducted as service evaluations. Papers ranged in publication dates from 1978 to 2019, and all services reported positive outcomes with respect to their main aim.…”

Section: Resultsmentioning

confidence: 99%

“…Thirteen papers stated that the pharmacist delivering the service was a ‘consultant’, and twelve papers noted that the pharmacist was described as ‘clinical’ . Five papers reported that the pharmacist had completed an accreditation process, one of which described the training as consisting of consultation skills, identification of drug‐related problems, guidelines and how to create pharmaceutical care plans.…”

Section: Resultsmentioning

confidence: 99%

“…Six papers reported the pharmacists being provided with a tool to support the service, and these included the medication stopping (STOPP) and medication initiation (START) tools, Geriatric Risk Assessment MedGuide (GRAM) software, Dader method of pharmacotherapy follow‐up, Beers criteria, GheOP‐S tool, antipsychotic use survey tool and other unspecified toolkits …”

Section: Resultsmentioning

confidence: 99%

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Systematic review and narrative synthesis of pharmacist provided medicines optimisation services in care homes for older people to inform the development of a generic training or accreditation process

Wright

Maskrey

Blyth

et al. 2019

International Journal of Pharmacy Practice

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Objectives To develop a training programme to enable pharmacists with prescribing rights to assume responsibility for the provision of pharmaceutical care within care homes, a systematic review and narrative synthesis was undertaken to identify reported approaches to training pharmacists and use this literature to identify potential knowledge requirements. Methods A PROSPERO-registered systematic review was performed using key search terms for care homes, pharmacist, education, training and pharmaceutical care. Papers reporting primary research focussed on care of the older person within the care home setting were included. No restrictions were placed on methodology. Two researchers independently reviewed titles, abstracts and papers. Agreement on inclusion was reached through consensus. Data on titles, training and activities undertaken were extracted and knowledge requirements identified. Findings were synthesised and reported narratively. Key findings Fifty-nine papers were included, most of which were uncontrolled service evaluations. Four papers reported an accreditation process for the pharmacist. Thirteen papers reported providing tools or specific training on a single topic to pharmacists. The main clinical and therapeutic areas of activity (requiring codified knowledge) were dementia, pain, antipsychotic and cardiovascular medication. Provision of pharmaceutical care, effective multidisciplinary working and care home staff training represented the main areas of practical knowledge. Conclusions Information regarding training and accreditation processes for care home pharmacists is limited. This study provides insight into potential codified and practical knowledge requirements for pharmacists assuming responsibility for the provision of pharmaceutical care within care homes. Further work involving stakeholders is required to identify the cultural knowledge requirements and to develop a training and accreditation process.

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Impact of pharmaceutical care on cardiovascular risk among older HIV patients on antiretroviral therapy

2016

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Background Advances in the treatment of HIV infection have enabled better control of the disease, allowing patients to enjoy a longer life expectancy. However, the ageing of patients leads to an increased prevalence of cardiovascular disease. Various studies have found that pharmaceutical care results in better control of cardiovascular risk factors. Objective To measure the impact of pharmaceutical care on cardiovascular risk in patients older than 50 years receiving combination antiretroviral therapy. Setting Outpatient pharmacy service of a tertiary hospital, Spain. Methods A pre/post-intervention quasi-experimental clinical study was conducted in which health education and pharmacist interventions to reduce cardiovascular risk factors were carried out in a single patient cohort using the Dader method of pharmacotherapy, with a 12-month follow-up period per patient. Patients included were older than 50 years, with moderate/elevated cardiovascular risk. Data were obtained from patient clinical histories, dispensing records and patient interviews, and were subjected to statistical analysis. Main outcome measure Cardiovascular risk estimated by SCORE and REGICOR equations. Results Forty-two patients completed the study. Of these, 93 % were men, with an average age of 57 years and 15 years since diagnosis of HIV. A reduction was observed in the mean values (baseline vs. 12 months) of the following cardiovascular risk factors: systolic blood pressure (P = 0.009), diastolic blood pressure (P = 0.010), total cholesterol (P = 0.006), low-density lipoprotein cholesterol (LDL-c; P = 0.039), triglycerides (P = 0.010) and total cholesterol/high-density lipoprotein cholesterol (HDL-c; P < 0.001). An increase in HDL-c (P = 0.037) was also observed. The average cardiovascular risk estimated by the SCORE instrument was reduced from 7.6 % at the beginning of the study to 6.4 % after 12 months (P = 0.039). The risk estimate according to REGICOR also decreased (P = 0.002). Over the 12-month period, 6.3 ± 3.4 interventions were carried out per patient. Quantitative ineffectiveness was the most prevalent negative outcome associated with medication throughout the study, and noncompliance was the most frequent cause. Interventions on health education were the most common, followed by interventions on improving adherence. Conclusion Pharmaceutical care, delivered as a combination of health education and pharmacotherapy follow-up to outpatients at a tertiary hospital, had a positive impact on cardiovascular risk in patients older than 50 years receiving combination antiretroviral therapy.

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Cost–Utility Analysis of a Pharmacotherapy Follow‐Up for Elderly Nursing Home Residents in Spain

Abstract: Pharmacotherapy follow-up is considered cost-effective for elderly NH residents in Spain.

Cited by 18 publications

References 31 publications

Cost-Utility Analysis of a Medication Review with Follow-Up Service for Older Adults with Polypharmacy in Community Pharmacies in Spain: The conSIGUE Program

Cost-Utility Analysis of a Medication Review with Follow-Up Service for Older Adults with Polypharmacy in Community Pharmacies in Spain: The conSIGUE Program

Systematic review and narrative synthesis of pharmacist provided medicines optimisation services in care homes for older people to inform the development of a generic training or accreditation process

Impact of pharmaceutical care on cardiovascular risk among older HIV patients on antiretroviral therapy

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