Evaluation of Pharmacists' Work in a Physician-Pharmacist Collaborative Model for the Management of Hypertension.
Evaluation of Pharmacists' Work in a Physician-Pharmacist Collaborative Model for the Management of Hypertension.
复制标题
DOI：
10.1002/phar.1727
复制
发表时间：
2016-04
期刊：
影响因子：
4.1
通讯作者：
James PA
中科院分区：
文献类型：
--
作者：
Isetts BJ;Buffington DE;Carter BL;Smith M;Polgreen LA;James PA
医生-药剂师合作模式已被证明可以改善对患有多种慢性疾病的患者的护理。使用综合临床药剂师的团队保健提供了一个机会，以提高质量的保健系统，使用人口为基础的融资。2015年11月，医疗保险和医疗补助服务中心（CMS）要求确定药剂师在团队护理中工作的相对价值。因此，本研究的目的是描述药师的工作组成部分，在高血压的管理与医师-药师合作模式。描述性分析的药剂师的工作组成部分，在药剂师和医生之间的合作，以改善结果现在（CAPTION）的研究，一个前瞻性，集群随机试验。这项分析的目的是为决策者提供数据和信息，使用CAPTION研究模型，关于药剂师工作的时间和强度，以了解药剂师在CMS筹资和人口管理目标方面的相对价值贡献。CAPTION试验在美国15个州的32个社区医疗办公室进行，包括390名具有多种心血管风险因素的患者。由每个办公室经过培训的研究协调员测量血压，如果患者血压不受控制，则将其纳入研究。纳入的患者被随机分为9个月干预组、24个月干预组或常规护理组。药剂师干预的目的是改善血压控制和解决阻碍血压目标进展的药物治疗问题。这种干预包括病历审查，与患者进行结构化评估，合作实现治疗目标，以及患者随访。两个干预组（9个月和24个月）在前9个月是相同的，该时间范围是本次工作量评价的重点。药剂师填写每例患者就诊的研究就诊表，并估计访视前、面对面护理和访视后活动花费的时间。在390名患者中，有2，811名患者与药剂师接触，涉及3.44小时/患者的面对面护理访视，加上1.55小时/患者的访视前和访视后工作。工作强度反映在与患者（43%的遭遇）和医生（1，169项建议，其中医生接受了1，153项[98.6%]）解决药物治疗问题的干预措施中，从而改善了患者的血压目标（根据主要研究终点，从基线时的0%到9个月时的43%）。药剂师为高血压患者提供了广泛的干预措施。该分析为卫生系统、提供者团体和支付者提供了一个框架，以衡量药剂师在基于价值的融资和人口管理方面的工作。
Physician-pharmacist collaborative models have been shown to improve the care of patients with numerous chronic medical conditions. Team-based health care using integrated clinical pharmacists provides one opportunity to improve quality in health care systems that use population-based financing. In November 2015, the Centers for Medicare and Medicaid Services (CMS) requested that the relative value of pharmacists’ work in team-based care needs to be established. Thus, the objective of this study was to describe the components of pharmacists’ work in the management of hypertension with a physician-pharmacist collaborative model. Descriptive analysis of the components of pharmacists’ work in the Collaboration Among Pharmacists and Physicians To Improve Outcomes Now (CAPTION) study, a prospective, cluster randomized trial. This analysis was intended to provide policymakers with data and information, using the CAPTION study model, on the time and intensity of pharmacists’ work to understand pharmacists’ relative value contributions in the context of CMS financing and population management aims. The CAPTION trial was conducted in 32 community-based medical offices in 15 U.S. states and included 390 patients with multiple cardiovascular risk factors. Blood pressure was measured by trained study coordinators in each office, and patients were included in the study if they had uncontrolled blood pressure. Included patients were randomized to a 9-month intervention, a 24-month intervention, or usual care. The goal of the pharmacist intervention was to improve blood pressure control and resolve drug therapy problems impeding progress toward blood pressure goals. This intervention included medical record review, a structured assessment with the patient, collaboration to achieve goals of therapy, and patient follow-up. The two intervention arms (9 months and 24 months) were identical the first 9 months, and that time frame is the focus of this workload evaluation. Pharmacists completed study encounter forms for every patient encounter and estimated time spent in pre-visit, face-to-face care, and post-visit activities. Among the 390 patients, there were 2,811 encounters with pharmacists that involved 3.44 hours/patient for face-to-face care visits plus 1.55 hours/patient for pre-visit and post-visit work. Intensity of work was reflected in interventions to resolve drug therapy problems with patients (43% of encounters) and with physicians (1,169 recommendations, of which physicians accepted 1,153 [98.6%]), resulting in improvement of patients’ blood pressure goals achieved (from 0% at baseline to 43% at 9 months based on the primary study endpoint). Pharmacists provided extensive interventions to patients with hypertension. This analysis provides a framework for health systems, provider groups, and payers to measure pharmacists’ work in value-based financing and population management.