Evaluation of the First Year of a Pilot Program in Community Pharmacy: HIV/AIDS Medication Therapy Management for Medi-Cal Beneficiaries
Evaluation of the First Year of a Pilot Program in Community Pharmacy: HIV/AIDS Medication Therapy Management for Medi-Cal Beneficiaries
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DOI：
10.18553/jmcp.2009.15.1.32
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发表时间：
2009-01-01
影响因子：
--
通讯作者：
Gilmer, Todd P.
中科院分区：
文献类型：
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作者：
Hirsch, Jan D.;Rosenquist, Ashley;Gilmer, Todd P.
背景技术背景：联合抗逆转录病毒疗法的出现提高了治疗效果，但对感染人类免疫缺陷病毒（艾滋病毒）的患者和管理患者药物治疗的社区药剂师提出了新的挑战。药剂师提供的药物治疗管理（MTM）服务能够提高药物依从性，改善健康结果，并降低整体医疗成本，这一点已在糖尿病和高血压等慢性病的社区药房中得到证实。然而，药剂师提供的MTM服务在艾滋病毒/获得性免疫缺陷综合征（艾滋病）的有效性还没有得到很好的研究。2005年1月，一个试点计划，以评估MTM服务的艾滋病毒/艾滋病患者开始在加州，允许10个艾滋病毒/艾滋病专业药房获得补偿的MTM服务，他们提供给艾滋病毒/艾滋病患者。（B）中间结果，包括类型和数量的抗逆转录病毒药物治疗方案，遵守率和过量药物填充抗逆转录病毒，使用禁忌的抗逆转录病毒治疗方案，和机会性感染的发生率;和（c）药房和医疗costs.METHODS：这是一项队列研究，检查2005年Medi-Cal药房和医疗索赔数据的艾滋病毒/艾滋病患者谁是由试点药房与其他药房。艾滋病毒/艾滋病患者是Medi-Cal受益人，截至2005年1月1日年满18岁，从2004年1月1日至2005年12月31日连续入组，并被诊断患有艾滋病毒/艾滋病，通过收到至少1份抗逆转录病毒药物处方和至少1份带有诊断的医疗索赔来识别在指数期（试点方案实施前一年，2004年）和干预期（研究年，2005年），对艾滋病毒/艾滋病（ICD-9-CM代码042.0）的（原发性或继发性）感染情况进行了调查。两个队列入选标准的唯一差异是，要求试点药房患者在2005年在10家试点药房中的一家药房填写了50%或更多的抗逆转录病毒处方。依从性定义为药物拥有率（MPR）为80%-120%，过量药物填充定义为MPR大于120%。使用双变量统计（分类变量的Pearson卡方检验和连续变量的t检验）进行组间比较。对于成本的比较，广义线性模型，假设伽玛分布和对数链接函数被使用;模型的预测变量包括年龄，性别，种族/民族，和双重覆盖下Medicare.RESULTS：共7,018艾滋病毒/艾滋病患者在Medi-Cal人口被确定为符合研究标准。其中，19.3%（n= 1，353）为试点药房患者。试点药房患者的人口统计学特征与在其他药房接受药物治疗的患者相似，但不完全相同。大部分试点药房患者接受基于蛋白酶抑制剂的抗逆转录病毒药物治疗方案（63.8%对54.8%，P
BACKGROUND: The advent of combined antiretroviral therapy (ART) has increased treatment effectiveness but created new challenges for patients infected with human immunodeficiency virus (HIV) and for community pharmacists managing patients' drug therapy. The ability of pharmacist-provided medication therapy management (MTM) services to increase medication adherence, improve health outcomes, and reduce overall medical costs has been demonstrated in community pharmacies for chronic diseases such as diabetes and hypertension. However, the effectiveness of pharmacist-provided MTM services in HIV/acquired immune deficiency syndrome (AIDS) has not been well studied. In January 2005, a pilot program to evaluate MTM services for patients with HIV/AIDS began in California, allowing 10 HIV/AIDS specialty pharmacies to receive compensation for the MTM services that they provided to HIV/AIDS patients.OBJECTIVES: To examine the first year of the HIV/AIDS pharmacy MTM compensation pilot program, which described and compared pilot and non-pilot pharmacies with respect to (a) patient characteristics; (b) intermediate outcomes including type and number of ART medication regimens used, rates of adherence and excess medication fills for ART, use of contraindicated ART regimens, and occurrence of opportunistic infections; and (c) pharmacy and medical costs.METHODS: This was a cohort study examining 2005 Medi-Cal pharmacy and medical claims data for patients with HIV/AIDS who were served by pilot pharmacies versus other pharmacies. The HIV/AIDS patients were Medi-Cal beneficiaries aged 18 years or older as of January 1, 2005, who were continuously enrolled from January 1, 2004, through December 31, 2005, and diagnosed with HIV/AIDS, identified by receipt of at least 1 ART prescription and at least 1 medical claim with a diagnosis (primary or secondary) of HIV/AIDS (ICD-9-CM code 042.0) during both the index period (the year before pilot program implementation, 2004) and the intervention period (the study year, 2005). The only difference in the inclusion criteria for the 2 cohorts was that the pilot pharmacy patients were required to have filled 50% or more of their antiretroviral prescriptions in 2005 at 1 of the 10 pilot pharmacies. Adherence was defined as a medication possession ratio (MPR) of 80%-120% and excess medication fills as MPR greater than 120%. Comparisons were made between groups using bivariate statistics (Pearson chi-square for categorical variables and t-tests for continuous variables). For comparisons of costs, generalized linear models assuming a gamma distribution and log link function were used; predictor variables for the models included age, gender, race/ethnicity, and dual coverage under Medicare.RESULTS: A total of 7,018 HIV/AIDS patients in the Medi-Cal population were identified as meeting the study criteria. Of these, 19.3% (n=1,353) were pilot pharmacy patients. The demographic profile of pilot pharmacy patients was similar, but not identical, to that of patients receiving medications at other pharmacies. A larger percentage of pilot pharmacy patients were on protease inhibitor-based ART medication regimens (63.8% vs. 54.8%, P