■基于预约的模式(ABM)是一种药学服务,旨在改善与药物相关的健康结果。ABM包括药物同步和药物审查,加上其他服务,如药物和解,药物治疗管理,疫苗管理,和多种药物包装。ABM可以提高服药依从性,但是经济影响是未知的。
■评估全国连锁药店针对MedicareAdvantage受益人的ABM计划对护理总成本(TCOC)的影响。
本研究使用倾向评分匹配的队列设计,分析了从2017年4月7日至2020年2月29日的MedicareAdvantageD部分受益人的行政索赔数据。国家连锁药店提供了ABM参与者的名单。ABM和对照(非ABM)组的资格标准包括索引日期的65岁或以上(初始参与,ABM;随机填写日期,对照)和从至少6个月的索引前(基线)日期到至少6个月的索引后(随访)日期的连续招募。医疗通胀调整后(2020年)TCOC计算为MedicareAdvantage受益人与D部分计划和患者支付金额的所有医疗保健支出之和,标准化为每个患者每月(PPPM),在随访期间。次要结果包括使用覆盖天数比例(PDC)计算的跨普遍维持治疗类别的药物依从性。
■每组包含5,225名匹配后具有平衡特征的患者:64%为女性,73%白色,平均年龄75岁,平均Quan-Charlson合并症指数评分为0.9,高血压和血脂异常,每个>65%。ABM和对照组的基准全因PPPM医疗保健费用中位数,分别,分别为517美元和548美元(221美元和234美元,$135和$164药房)。在ABM组中,至少80%的基线PDC为83%,同样,对照组为84%。平均(SD)随访为ABM组604(155)天,对照组598(151)天。在后续期间,ABM组的PPPMTCOC中位数为$656,对照组为$723(P=0.011).ABM组的药房费用中位数也明显较低(161美元对193美元,P<0.001),而ABM组的中位医疗费用为$328,对照组为$358(P=0.254).ABM组中更多的患者在随访期间粘附,84%的PDC至少达到80%,对照组为82%(P=0.009)。
■ABM计划与随访中位数总费用(医疗和药房)显着降低相关,主要由药房成本驱动。更多的患者坚持ABM计划。付款人和药房可以使用这些证据来评估其会员的ABM计划。
UNASSIGNED: The appointment-based model (ABM) is a pharmacy service to improve medication-related health outcomes. ABM involves medication synchronization and medication review, plus other services such as medication reconciliation, medication therapy management, vaccine administration, and multimedication packaging. ABM can improve medication adherence, but the economic impact is unknown.
UNASSIGNED: To assess the effect of a national pharmacy chain\'s ABM program for Medicare Advantage beneficiaries on total cost of care (TCOC).
UNASSIGNED: This study analyzed administrative claims data from April 7, 2017, through February 29, 2020, for Medicare Advantage beneficiaries with Part D using a propensity score-matched cohort design. The national pharmacy chain provided a list of ABM participants. Eligibility criteria for the ABM and control (non-ABM) groups included age 65 years or older on the index date (initial participation, ABM; random fill date, control) and continuous enrollment from at least 6 months pre-index (baseline) date through at least 6 months post-index (follow-up) date. Medical inflation-adjusted (2020) TCOC was calculated as the sum of all health care spending from Medicare Advantage beneficiaries with Part D plan and patient paid amounts, standardized to per patient per month (PPPM), during the follow-up period. Secondary outcomes included medication adherence calculated across prevalent maintenance therapeutic classes using proportion of days covered (PDC).
UNASSIGNED: Each group contained 5,225 patients with balanced characteristics after matching: 64% female, 73% White, mean age 75 years, mean Quan-Charlson comorbidity index score 0.9, and hypertension and dyslipidemia, each >65%. Median baseline all-cause PPPM health care costs in the ABM and control groups, respectively, were $517 and $548 ($221 and $234 medical, $135 and $164 pharmacy). Baseline PDC of at least 80% was 83% in the ABM group and, similarly, 84% in the control group. The mean (SD) follow-up was 604 (155) days for the ABM group and 598 (151) days for the control group. During the follow-up period, the median PPPM TCOC for the ABM group was $656 and was $723 for the control group (P = 0.011). Median pharmacy costs were also significantly less in the ABM group ($161 vs $193, P < 0.001), whereas median medical costs were $328 in the ABM group and $358 among controls (P = 0.254). More patients in the ABM group were adherent during follow-up, with 84% achieving PDC of at least 80% vs 82% among controls (P = 0.009).
UNASSIGNED: The ABM program was associated with significantly lower follow-up median total costs (medical and pharmacy), driven primarily by pharmacy costs. More patients were adherent in the ABM program. Payers and pharmacies can use this evidence to assess ABM programs for their members.