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

© 2015, Springer International Publishing Switzerland. Background: The concept of pharmaceutical care is operationalized through pharmaceutical professional services, which are patient-oriented to optimize their pharmacotherapy and to improve clinical outcomes. Objective: The 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. Methods: The study was designed as a cluster randomized controlled trial, and was carried out over a time horizon of 6 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. Cost-utility analysis adopted a health service perspective. Costs were in euros at 2014 prices and the effectiveness of the intervention was estimated as quality-adjusted life-years (QALYs). In order to analyze the uncertainty of ICER results, we performed a non-parametric bootstrapping with 5000 replications. Results: A total of 1403 older adults, aged between 65 and 94 years, were enrolled in the study: 688 in the intervention group (IG) and 715 in the control group (CG). By the end of the follow-up, both groups had reduced the mean number of prescribed medications they took, although this reduction was greater in the IG (0.28 ± 1.25 drugs; p < 0.001) than in the CG (0.07 ± 0.95 drugs; p = 0.063). Older adults in the IG saw their quality of life improved by 0.0528 ± 0.20 (p < 0.001). In contrast, the CG experienced a slight reduction in their quality of life: 0.0022 ± 0.24 (p = 0.815). The mean total cost was €977.57 ± 1455.88 for the IG and €1173.44 ± 3671.65 for the CG. In order to estimate the ICER, we used the costs adjusted for baseline medications and QALYs adjusted for baseline utility score, resulting in a mean incremental total cost of −€250.51 ± 148.61 (95 % CI −541.79 to 40.76) and a mean incremental QALY of 0.0156 ± 0.004 (95 % CI 0.008–0.023). Regarding the results from the cost-utility analysis, the MRF service emerged as the dominant strategy. Conclusion: The MRF service is an effective intervention for optimizing prescribed medication and improving quality of life in older adults with polypharmacy in community pharmacies. The results from the cost-utility analysis suggest that the MRF service is cost effective

Opinión De Un Grupo De Expertos Sobre Facilitadores Para La Implantación Del Seguimiento Farmacoterapéutico En Las Farmacias Comunitarias Españolas - Opinion of a group of experts on facilitators for introducing pharmacotherapy follow up in Spanish communities

A focus group, consisting of members of the Community Pharmacy Pharmaceutical Care Forum, was created as part of a research study into prioritising facilitators for introducing pharmaceutical follow-up in Spanish community pharmacies The aim was to explore their options regarding the facilitators prioritised in this study that had been defined as “Incentives”, “External Campaigns”, “Expertise in Pharmacotherapy Follow-Up Service” and “Pharmacist Professionalism”. The priority facilitator of the study, “Incentives”, mainly includes economic incentives, which are essential for the introduction and sustainability of pharmacotherapy follow-up services, although they also refer to other kinds of incentive, such as professional recognition. The participants agreed with the results of the study, which indicate the need for a preliminary payment to introduce new professional services. It is considered that this payment is justified by the benefits that the pharmacotherapy follow-up service offers patients’ health and the reduction in health expenses derived from the correct use of medication. Therefore, various methods of economic incentives for pharmacists who offer pharmacotherapy follow-up services were proposed. As far as professional recognition is concerned, the accreditation of the pharmacy that offers pharmacotherapy follow-up services was considered to be an incentive, and that this service should be relevant at a curricular level. Carrying out external campaigns as well as the existence of a professional pharmaceutical expert, qualified and accredited to offer the new professional pharmaceutical services (PPS) were also confirmed as being very important

Opinión de un grupo de expertos sobre facilitadores para la implantación del seguimiento farmacoterapéutico en las farmacias comunitarias españolas

En el contexto de un estudio de investigación sobre priorización de facilitadores para la implantación del Seguimiento Farmacoterapéutico en las farmacias comunitarias españolas, se realizó un grupo focal compuesto por miembros de Foro de Atención Farmacéutica en Farmacia Comunitaria. El objetivo era explorar sus opiniones sobre los facilitadores priorizados en dicho estudio que se habían definido como “Incentivos”, “Campañas externas”, “Experto en SFT” y “Profesionalidad del farmacéutico”. El facilitador prioritario del estudio, denominado “incentivos”, incluye fundamentalmente incentivos económicos, imprescindibles en la implantación y sostenibilidad del Seguimiento Farmacoterapéutico, aunque también hace referencia a otro tipo de incentivo como el reconocimiento profesional. Los participantes estaban de acuerdo con los resultados del estudio, que indican la necesidad de un pago previo para implantar nuevos servicios profesionales. Se considera que este pago queda justificado por los beneficios que la realización del Seguimiento Farmacoterapéutico aporta a la salud del paciente y a la reducción del gasto sanitario derivado de un buen uso de la medicación. Por consiguiente, se plantearon distintos métodos para incentivar económicamente a la farmacia que realiza Seguimiento Farmacoterapéutico. En cuanto al reconocimiento profesional, se consideró como un incentivo la acreditación de la farmacia que realiza SFT y que su provisión tenga relevancia a nivel curricular. Se confirma también como de gran importancia tanto la realización de campañas externas como la existencia de un experto farmacéutico profesional, preparado y acreditado para realizar nuevos SPF