Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): Multicentre randomised placebo-controlled trial

Aim
To review and evaluate the most recent literature on the economic outcomes of pharmacist-managed services in people with diabetes.

Background
The global prevalence of diabetes is increasing. Although pharmacist-managed services have been shown to improve people's health outcomes, the economic impact of these programmes remains unclear.

Methods
A systematic review was conducted of six databases. Study inclusion criteria were: (1) original research; (2) evaluation of pharmacist-managed services in people with diabetes; (3) an economic evaluation; (4) English-language publication; and (5) full-text, published between January 2006 and December 2014. The quality of the full economic evaluations reviewed was evaluated using the Consolidated Health Economic Evaluation Reporting Standards checklist.

Results
A total of 2204 articles were screened and 25 studies were selected. These studies were conducted in a community pharmacy (n = 10), a clinic- /hospital-based outpatient facility (n = 8), or others. Pharmacist-managed services included targeted education (n = 24), general pharmacotherapeutic monitoring (n = 21), health screening or laboratory testing services (n = 9), immunization services (n = 2) and pharmacokinetic monitoring (n = 1). Compared with usual care, pharmacist-managed services resulted in cost savings that varied from $7 to $65,000 ($8 to $85,000 in 2014 US dollars) per person per year, and generated higher quality-adjusted life years with lower costs. Benefit-to-cost ratios ranged from 1:1 to 8.5:1. Among the 25 studies reviewed, 11 were full economic evaluations of moderate quality.

Conclusions
Pharmacist-managed services had a positive return in terms of economic viability. With the expanding role of pharmacists in the healthcare sector, alongside increasing health expenditure, future economic studies of high quality are needed to investigate the cost-effectiveness of these services.

Economic evaluations of pharmacist-managed services in people with diabetes mellitus: a systematic review

Aim: To assess feasibility and patient satisfaction with a pharmacist-delivered medication therapy management (MTM) plus pharmacogenetic (PGx) testing service. Methods: Thirty patients from a cardiology outpatient clinic were enrolled to attend two MTM sessions, undergo PGx testing and complete pre- and post-intervention surveys. Outcome measures included duration of MTM sessions, clinical application of test results, self-reported medication adherence, patient recall of results and perceived value of testing and MTM. Results: Overall, patients were very satisfied with the MTM plus PGx testing service. About half of participants (47%) were able to accurately recall their PGx test results. Comparable to MTM without PGx testing, the first MTM session averaged 40 min and the follow-up MTM session averaged 15 min. Conclusion: PGx testing incorporated into a clinical MTM service offered by pharmacists may be a feasible delivery model and is satisfactory to patients.

Incorporation of pharmacogenetic testing into medication therapy management

Since the introduction of pharmaceutical care concept by Hepler and Strand in 1990, community pharmacists worldwide have been realigning their roles from being product-focused to patient-orientated to improve patient's quality of life. The objectives of this study were to determine the type of services, with emphasis on the extent of pharmaceutical care services provided by community pharmacists and the barriers in providing such services in Malaysia. A cross-sectional observational study was conducted using an online questionnaire. Community pharmacists in Malaysia were invited to participate in the study via emails. The questionnaire was structured based on the Malaysian Community Pharmacy Benchmarking Guidelines, the five practice principles of pharmaceutical care by the American Pharmacists Association and other studies. The online questionnaire was opened for 6 months, from April to September 2018. A reminder to participate was sent via email to the community pharmacists every fortnight. A total of 420 community pharmacists responded to the online questionnaire. Besides essential services such as treatment for minor illness, medicine dispensing and counselling, most of the respondents were providing health screening and monitoring (99.5%), selection and recommendation of health supplements (90.5%), patient medication review (68.8%), weight management (52.4%) and counselling on smoking cessation (51.0%). More than half (53.3%) of the respondents reported that they were providing pharmaceutical care services to patients with chronic diseases. Based on the practice principles of pharmaceutical care, the respondents were involved in patients' data collection (23.3%), medical information evaluation (18.6%), formulating a drug therapy plan (9.3%), implementing a drug therapy plan (4.5%), and monitoring and modifying the plan (18.3%). Lack of separation between prescribing and dispensing was perceived as the main barrier to the implementation of pharmaceutical care services by a majority of the respondents (84.0%). The present study found that pharmaceutical care services provided by community pharmacists in Malaysia were inadequate compared to international practice principles. Areas that need improvement included collaboration with patients' other health care providers; more proactive management of patient's medicine regimen; having proper patient monitoring and follow-up mechanisms, and documentation.

/pdf/the-extent-and-barriers-in-providing-pharmaceutical-care-4gm86y4a97.pdf

The extent and barriers in providing pharmaceutical care services by community pharmacists in Malaysia: a cross-sectional study.

Objectives To assess the impact of technician involvement on the completion of medication therapy management (MTM) services in a community pharmacy setting and to describe pharmacists' and technicians' perceptions of technician involvement in MTM-related tasks and their satisfaction with the technician's role in MTM. Design Prospective observational study. Setting and participants In the fall of 2015, pharmacists and selected technicians from 32 grocery store–based community pharmacies were trained to use technicians within MTM services. Main outcome measures Completed MTM claims were evaluated at all pharmacies for 3 months before training and 3 months after training. An electronic survey, developed with the use of competencies taught in the training and relevant published literature, was distributed via e-mail to trained employees 3 months after training. Results The total number of completed MTM claims at the 32 pharmacy sites was higher during the posttraining time period (2687 claims) versus the pretraining period (1735 claims). Of the 182 trained participants, 112 (61.5%) completed the survey. Overall, perceived technician involvement was lower than expected. However, identifying MTM opportunities was the most commonly reported technician MTM task, with 62.5% of technicians and 47.2% of pharmacists reporting technician involvement. Nearly one-half of technicians (42.5%) and pharmacists (44.0%) agreed or strongly agreed they were satisfied with the technician's role in MTM services, and 40.0% of technicians agreed that they were more satisfied with their work in the pharmacy after involvement in MTM. Conclusion Three months after initial training of technicians in MTM, participation of technicians was lower than expected. However, the technicians involved most often reported identifying MTM opportunities for pharmacists, which may be a focus for future technician trainings. In addition, technician involvement in MTM services may increase satisfaction with many aspects of work for actively involved technicians.

Pharmacy technician involvement in community pharmacy medication therapy management

Background The purpose of this study was to determine the cost savings of a pharmacist-led, employer-sponsored medication therapy management (MTM) program for diabetic patients and to assess for any changes in patient satisfaction and self-reported medication adherence for enrollees. Methods Participants in this study were enrollees of an employer-sponsored MTM program. They were included if their primary medical insurance and prescription coverage was from the City of Toledo, they had a diagnosis of type 2 diabetes, and whether or not they had been on medication or had been given a new prescription for diabetes treatment. The data were analyzed on a prospective, pre-post longitudinal basis, and tracked for one year following enrollment. Outcomes included economic costs, patient satisfaction, and self-reported patient adherence. Descriptive statistics were used to characterize the population, calculate the number of visits, and determine the mean costs for each visit. Friedman's test was used to determine changes in outcomes due to the nonparametric nature of the data. Results The mean number of visits to a physician's office decreased from 10.22 to 7.07. The mean cost of these visits for patients increased from $47.70 to $66.41, but use of the emergency room and inpatient visits decreased by at least 50%. Employer spending on emergency room visits decreased by $24,214.17 and inpatient visit costs decreased by $166,610.84. Office visit spending increased by $11,776.41. A total cost savings of $179,047.80 was realized by the employer at the end of the program. Significant improvements in patient satisfaction and adherence were observed. Conclusion Pharmacist interventions provided through the employer-sponsored MTM program led to substantial cost savings to the employer with improved patient satisfaction and adherence on the part of employees at the conclusion of the program.

Improving the economic and humanistic outcomes for diabetic patients: making a case for employer-sponsored medication therapy management

POSB17 Ozanimod for the Treatment of Biologic-Experienced Patients with Moderate-to-Severe Ulcerative Colitis: Results from a Systematic Literature Review and Network Meta-Analyses

A Retrospective Analysis to Identify Factors that Predict Adherence with HMG-CoA Reductase Inhibitors (statins) among University of Toledo Employees with Diabetes

MT30 Medtech Innovations in Oncology: A Review of NICE Medtech Innovation Briefings from 2014 to 2022

MT41 Medical Technology Guidance: A Review to Identify the Evidence Gaps and Data Needs

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