Cost-Effectiveness Analysis of the Ageing-in-Place (Aip) Programme (original) (raw)
Related papers
Pharmacist Intervention Program at Different Rent Levels of Geriatric Healthcare
Pharmacy, 2017
As a pharmacy service giving pharmaceutical care at different levels of health care for elderly people, we needed a standardization procedure for recording and evaluating pharmacists' interventions. Our objective was to homogenize pharmacist interventions; to know physicians' acceptance of our recommendations, as well as the most prevalent drug related problems (DRP); and the impact of the pharmacists' interventions. To achieve this goal we conducted a one year prospective study at two levels of health care: 176 nursing homes (EAR) (8828 patients) and 2 long-term and subacute care hospitals (HSS) (268 beds). Pharmacists' interventions were recorded using the American Society of Health-System Pharmacists classification as the basis. Frequency of the different DRP and the level of response and acceptance on the part of physicians was determined. The Medication Appropriateness Index (MAI) was used to evaluate the impact of the interventions on the prescription quality. Patients' mean age was 84.2 (EAR) and 80.7 (HSS), and in both cases, polypharmacy ≥ 9 drugs was around 63-69%. There were 4073 interventions done in EAR and 2560 in HSS. Level of response: 44% (EAR), 79% (HSS); degree of acceptance of the recommendations: 84% (EAR), 72% (HSS). Most frequent DRP: inappropriate dose, length of therapy, omissions, and financial impact. Drugs for the nervous system are those with the most DRP. MAI values/medication improved from 4.4 to 2.7 (EAR) and 3.8 to 1.7 (HSS). A normalized way of managing pharmacists' interventions for different health care levels has been established. We are on the way to increasing collaborative work with physicians and we know which DRPs are most prevalent.
Analysis on Clinical pharmacy services provided by pharmacists for promoting elderly patients care
International Journal of Research in Pharmaceutical Sciences, 2020
Clinical pharmacy services are the services provided by the pharmacists to promote patient care, optimizes medication therapy, promote health and disease prevention. This prospective cross sectional study was conducted in tertiary care hospital over a period of 6 months. This collected data is checked for their appropriateness of any prescription related errors and DRPs were identified. Results obtained were assessed to determine the influence of Clinical pharmacist services. Majority of the prescriptions were with 5-9(62.5%) drugs. The majority of co-morbidities among 125 enrolled patients in age group of 60-70, 55 patients were with 3-4 co-morbidities. Among 125 prescriptions around 12 prescriptions were identified with 622 drug interactions. Among 125 patients 2 (0.277) adverse drug reactions were observed and according to Naranjo's probability assessment scale these adverse drug reactions were mild and 15(2.08%) dispensing errors, 10(1.386%) prescription errors where majorit...
The cost-effectiveness of a clinical pharmacist intervention among elderly outpatients
Pharmacotherapy
We estimated the cost and cost-effectiveness of a clinical pharmacist intervention known to improve the appropriateness of drug prescribing. Elderly veteran outpatients prescribed at least five drugs were randomized to an intervention (105 patients) or control (103) group and followed for 1 year. The intervention pharmacist provided advice to patients and their physicians during all general medicine visits. Mean fixed and variable costs/intervention patient were 36and36 and 36and84, respectively Health services use and costs were comparable between groups. Intervention costs ranged from $7.50-30/patient/unit change in drug appropriateness. The cost to improve the appropriateness of drug prescribing is thus relatively low.
Pharmacists in Aged Care Facilities
Comprehensive Review, 2019
Medication Related Problems (MRPs) have been estimated to cost approximately $177.4 billion per year and are estimated to be one of the top 5 causes of death in the elderly population. Approximately 20% of elderly residents experience a significant delay in medication administration and missed doses. More than 60% of seniors over 65 get admitted to hospitals due to pneumonia, reported by AAFP. Influenza and pneumonia combined add up to the sixth leading cause of death in America — 90% of these are senior adults. By 2056, 480,000 Canadian deaths per year are predicted with 90% of those deaths being eligible for palliative care. Prescribing in the older population is highly complex. Age-related pharmacokinetic and pharmacodynamic changes lead to variations in drug bioavailability, increased drug sensitivity, and decreased regulatory mechanisms, altering the effects of drug usage from those observed in younger populations. In addition, the presence of multiple co-morbidities necessitating multiple medication usage equates to an increased risk of medication misadventure in older adults. Advancing age is positively correlated with increased prevalence of chronic disease, and increased number of co-morbidities correlates with increased medication use. Community pharmacists are among the most accessible front-line primary care practitioners and are well positioned to affect the care of home-bound patients. Pharmacist-directed home medication reviews could serve to minimize inappropriate use of medication, maximize health care cost savings and expand the scope of pharmacy practice.
Therapeutics and clinical risk management, 2018
The elderly population is the largest consumer of medications as this age group is at high risk for developing chronic diseases. However, medication use among elderly people is complicated by an increased risk of drug-related problems. Therefore, the present study was conducted to investigate the effects of collaborative interventions between pharmacists and physicians on health-related outcomes of elderly patients. This was a randomized controlled trial (RCT) conducted on elderly outpatients who sought treatment in the Medical Outpatient Department of a public tertiary hospital in Malaysia and who were taking at least five medications. The participants were randomly allocated to the intervention and control groups. The intervention group received pharmaceutical care from a pharmacist in collaboration with physicians and was followed-up for 6 months, while the control group received usual care in the outpatient pharmacy. A total of 73 participants in the intervention group and 79 pa...
Authorea (Authorea), 2023
Aim. To investigate the impact of pharmacists' presence in long-term care facilities (LTCFs) on medication usage. Methods. The study followed a retrospective cohort design, with a sample of patients aged [?] 65 years old admitted to 3 LTCFs over 30 months. Data on age, gender, type of stay, presence/absence of pharmacist and medication at admission and discharge were obtained for study patients. Variations in the number of medicines (NoM), anticholinergic burden (ACB), and potentially inappropriate medication (PIMs), at admission and discharge, were assessed as outcome variables. Anticholinergic burden and PIMs were identified using the Anticholinergic Cognitive Burden scale and the EU(7)-PIM List, respectively. One-sample t-tests were applied to compare outcome variables' mean values at admission and discharge. A 4-way ANOVA was employed to test the association between background and outcome variables. Partial Eta squared (η2) was used to measure the effect size. Results. The 3 LTCFs assisted 1643 patients during the study period, of which 1366 were included in data analysis. Only one LTCF had pharmacy services. All outcome variables showed a statistically significant increase at discharge compared with admission. Pharmacist's presence was statistically significant at improving the NoM (p<0.001) and ACB score (p<0.001), while no statistically significant value was reached on PIMs (p = 0.642). Small effect size values were reached for pharmacist impact on the NoM and ACB score (η2 = 0.021, η2 = 0.011, respectively). Conclusion. The present findings suggest that pharmacists' presence positively impacts the use of medications implicated in adverse health outcomes in LTC patients.
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2003
Pharmacists can improve patient outcomes in institutional and pharmacy settings, but little is known about their effectiveness as consultants to primary care physicians. We examined whether an intervention by a specially trained pharmacist could reduce the number of daily medication units taken by elderly patients, as well as costs and health care use. We conducted a randomized controlled trial in family practices in 24 sites in Ontario. We randomly allocated 48 randomly selected family physicians (69.6% participation rate) to the intervention or the control arm, along with 889 (69.5% participation rate) of their randomly selected community-dwelling, elderly patients who were taking 5 or more medications daily. In the intervention group, pharmacists conducted face-to-face medication reviews with the patients and then gave written recommendations to the physicians to resolve any drug-related problems. Process outcomes included the number of drug-related problems identified among the ...
Geriatric Patient Care by U.S. Pharmacists in Healthcare Teams: Systematic Review and Meta-Analyses
Journal of the American Geriatrics Society, 2013
OBJECTIVES: To conduct a systematic review and metaanalyses to examine the effects of pharmacists' care on geriatric patient-oriented health outcomes in the United States (U.S.). DESIGN: Studies examining U.S. pharmacists' patient care services from inception of the databases through July 2012 were searched. The databases searched include PubMed/ MEDLINE, Ovid/MEDLINE, ABI/INFORM, Health Business Fulltext Elite, Academic Search Complete, International Pharmaceutical Abstracts, PsycINFO, Cochrane Database, and ClinicalTrials.gov. Studies reporting pharmacists' intervention for geriatric patients, comparison groups, and patient-oriented outcomes were assessed. Dual review for inclusion and data extraction were performed. SETTING: University of Arizona College of Pharmacy. MEASUREMENTS: Study and participant characteristics, pharmacist intervention, and outcomes with data for metaanalyses were collected. A forest plot was constructed to obtain a pooled standardized mean difference using a random effects model. RESULTS: One hundred fifty-two articles were reviewed, with 20 resulting studies included in the final meta-analyses. Study sample size ranged from 36 to 4,218, with mean age of subjects being 65 and older. The studies were most frequently conducted in ambulatory care clinics, followed by inpatient settings; the majority focused on multiple diseases and conditions. Pharmacist activities varied widely, with technical interventions used most often. Favorable results were found in all outcome categories, and metaanalyses conducted for therapeutic, safety, hospitalization, and adherence were significant (P < .001), favoring pharmacist care over comparison. Some identifiable variability existed between included studies.