Cost effectiveness of support for people starting a new medication for a long term condition through community pharmacies: an economic evaluation of the New Medicine Service (NMS) compared with normal practice

Background: The English community pharmacy New Medicine Service (NMS) significantly increases patient adherence to medicines, compared with normal practice. We examined the cost-effectiveness of NMS compared with normal practice by combining adherence improvement and intervention costs with the effect of increased adherence on patient outcomes and healthcare costs. Methods: We developed Markov models for diseases targeted by the NMS (hypertension, type 2 diabetes, chronic obstructive pulmonary disease, asthma and antiplatelet regimens) to assess the impact of patients’ non-adherence. Clinical event probability, treatment pathway, resource-use and costs were extracted from literature and costing tariffs. Incremental costs and outcomes associated with each disease were incorporated additively into a composite probabilistic model and combined with adherence rates and intervention costs from the trial. Costs per extra quality-adjusted-life-year(QALY) were calculated from the perspective of NHS England, using a lifetime horizon. Results: NMS generated a mean of 0.05 (95%CI: 0.00, 0.13) more QALYs per patient, at a mean reduced cost of -£144 (95%CI: -769, 73). The NMS dominates normal practice with probability of 0.78 (ICER: - £3166 per QALY). NMS has a 96.7% probability of cost-effectiveness compared with normal practice at a willingness-to-pay of £20000 per QALY. Sensitivity analysis demonstrated that targeting each disease with NMS has a probability over 0.90 of cost-effectiveness compared with normal practice at a willingness-to-pay of £20000 per QALY. Conclusions: Our study suggests that the New Medicine Service increased patient medicine adherence compared with normal practice, which translated into increased health gain at reduced overall cost

Improving medication safety in the elderly.

Contains fulltext : 71163.pdf (publisher's version ) (Open Access)RU Radboud Universiteit Nijmegen, 13 maart 2008Promotores : Smet, P.A.G.M. de, Grol, R.P.T.M. Co-promotor : Dautzenberg, M.G.H.191 p

A composite screening tool for medication reviews of outpatients: general issues with specific examples.

Contains fulltext : 52948.pdf (publisher's version ) (Open Access)Regular performance of medication reviews is prominent among methods that have been advocated to reduce the extent and seriousness of drug-related problems, such as adverse drug reactions, drug-disease interactions, drug-drug interactions, drug ineffectiveness and cost ineffectiveness. Several screening tools have been developed to guide practising healthcare professionals and researchers in reviewing the medication patterns of elderly patients; however, each of these tools has its own limitations. This review discusses a wide range of general prescription-, treatment- and patient-related issues that should be taken into account when reviewing medication patterns by implicit screening. These include generic and therapeutic substitution; potentially superfluous or inappropriate medications; potentially inappropriate dosages or duration of treatment; drug-disease and drug-drug interactions; under-treatment; making use of laboratory test results; patient adherence, experiences and habits; appropriate dosage forms and packaging. A broad selection of specific examples and references that can be used as a basis for explicit screening of medication patterns in outpatients is also offered

Comparison of two methods for performing treatment reviews by pharmacists and general practitioners for home-dwelling elderly people.

Contains fulltext : 71243.pdf (publisher's version ) (Closed access)RATIONALE, AIMS AND OBJECTIVES: There is room for improvement in pharmacotherapy for elderly outpatients. Studies have shown that collaborating health care professionals [e.g. pharmacists in cooperation with general practitioners (GPs)] are able to resolve prescription-related pharmaceutical care issues by means of treatment reviews. The aim of the study was to describe the feasibility of two methods for treatment review (results were given to the GP either in case conferences or in written feedback), and to determine if and how the process of treatment review can be improved. SETTING: Local pharmacists and GPs cooperated in performing treatment reviews for outpatients aged 75 years or more who were using five or more medicines chronically. METHOD: Written questionnaires, structured telephone interviews and analysis of various features of the treatment reviews that were recorded during the intervention study were used. RESULTS: The pharmacists in the case conference group made more recommendations to the GPs (non-significant). Significantly more recommendations were identified by the pharmacists themselves in the case conference group. Health care professionals accepted an intervention with personal contact in case conferences better than an intervention with feedback in writing. They were more positive about the process of treatment review presented personally, although there were not always as many medication changes as they had hoped for. They also had concrete suggestions for improving the intervention, such as using a combination of written feedback and case conferences, and reserving the case conferences for the most complex cases. CONCLUSIONS: Treatment reviews for the elderly in normal primary care are feasible. Health care professionals agree that the process for treatment review can be improved

Alleen gemotiveerde patiënten stoppen. Effect van 'minimale interventie' van de openbare apotheek bij rokers.

Contains fulltext : 58067.pdf (publisher's version ) (Open Access