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Valentijn PP, Tymchenko L, Gruisen W, Bruls B, Abdalla Pereira F, Arends RY. Effectiveness of Integrated Care for Diabetes Mellitus Type 2, Cardiovascular and Chronic Respiratory Diseases: A Systematic Review and Meta-Analysis. Int J Integr Care 2024; 24:16. [PMID: 39184531 PMCID: PMC11342834 DOI: 10.5334/ijic.7744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 08/01/2024] [Indexed: 08/27/2024] Open
Abstract
Introduction In this paper, we use the Rainbow Model of Integrated Care (RMIC) framework to evaluate the effectiveness of integrated care in terms of enhancing the outcomes of chronic conditions such as diabetes mellitus type 2 (DMT2), cardiovascular diseases (CVD), chronic respiratory diseases (CRD), or their combinations. Methods The data extracted from randomized controlled trials (RCT) of integrated care interventions for DMT2, CVD, and CRD (follow-up ≥ 3 months) in 11 databases were analysed using random-effects meta-analysis. Results A total of 54 eligible studies covering 12,976 participants, with a mean follow-up of 54 weeks, were included. In moderate-quality evidence, integrated care interventions reduced mortality for CVD, adverse events for CVD and DMT2, and improved quality of life for CVD and DMT2, physical and mental functioning, self-management, and blood pressure control. Conclusion Integrated care can reduce all-cause mortality, adverse events, and improve quality of life, physical and mental functioning, self-management and blood pressure control in chronic disease patients. However, available evidence for some outcomes (e.g., all-cause hospital admissions) remains uncertain.
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Affiliation(s)
- Pim P. Valentijn
- Essenburgh Research & Consultancy, Essenburgh Group, Harderwijk, the Netherlands
- Research Group Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands
| | - Liza Tymchenko
- Essenburgh Research & Consultancy, Essenburgh Group, Harderwijk, the Netherlands
| | - Wiro Gruisen
- Healthcare Division, CZ Health Insurance, Tilburg, the Netherlands
| | - Bem Bruls
- Health Centre Hoensbroek North, Hoensbroek, the Netherlands
- General Practitioners Eastern South Limburg, Heerlen, the Netherlands
| | | | - Rosa Y. Arends
- Essenburgh Research & Consultancy, Essenburgh Group, Harderwijk, the Netherlands
- University of Applied Sciences Utrecht, Utrecht, the Netherlands
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Lo YT, Chen MH, Lu TH, Yang YP, Chang CM, Yang YC. Effects of an integrated ambulatory care program on healthcare utilization and costs in older patients with multimorbidity: a propensity score-matched cohort study. BMC Geriatr 2024; 24:109. [PMID: 38287245 PMCID: PMC10826123 DOI: 10.1186/s12877-023-04654-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 12/31/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Population aging has increased the prevalence of multimorbidity, jeopardizing the sustainability and efficiency of healthcare systems. This study aimed to evaluate the effects of an integrated ambulatory care program (IACP) on healthcare utilization and costs among older patients with multimorbidity while accounting for the confounding effects of frailty. METHODS A retrospective cohort study using propensity matching including patients aged 65 or older with two or more chronic conditions attending the outpatient clinic at our hospital between June 1 and December 31, 2019, was conducted. Exposure was defined as receipt of IACP care. Patients not undergoing the IACP comprised the unexposed group and were matched at a ratio of 1:4 to patients undergoing the IACP group according to sex, age, Charlson Comorbidity Index score, multimorbidity frailty index score, and number of outpatient visits within 6 months before the index date. Outcomes were changes in healthcare utilization and related costs between 6 months before and after receiving IACP care. Multivariate regression analyses were used for data analysis and the Generalized Estimation Equation method was used to fit the regression models. RESULTS A total of 166 (IACP) and 664 (non-exposed) patients were analyzed. The mean participant baseline ages were 77.15 ± 7.77 (IACP) and 77.28 ± 7.90 years (unexposed). In univariate analyses, the IACP group demonstrated greater reductions than the unexposed group in the frequency of outpatient visits (-3.16 vs. -1.36, p < 0.001), number of physicians visited (-0.99 vs. -0.17, p < 0.001), diagnostic fees (-1300 New Taiwan Dollar [NTD] vs. -520 NTD, p < 0.001), drug prescription fees (-250 NTD vs. -70 NTD, p < 0.001), and examination fees (-1620 NTD vs. -700 NTD, p = 0.014). Multivariate analyses demonstrated that patients in the IACP group experienced significant reduction in the frequency of outpatient visits (95% CI: -0.357 to -0.181, p < 0.001), number of physicians visited (95% CI: -0.334 to -0.199, p < 0.001), and overall outpatient costs (95% CI: -0.082 to -0.011, p = 0.01). However, emergency department utilization, hospitalization, and costs did not differ significantly. CONCLUSIONS Expanding IACPs may help patients with multimorbidity reduce their use of outpatient clinics at the 6-month follow-up, reduce care fragmentation, and promote sustainability of the healthcare system.
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Affiliation(s)
- Yu-Tai Lo
- Department of Geriatrics and Gerontology, National Cheng Kung University Hospital, College of medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Mei-Hua Chen
- Department of Geriatrics and Gerontology, National Cheng Kung University Hospital, College of medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tsung-Hsueh Lu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ya-Ping Yang
- Department of Nursing, National Tainan Junior College of Nursing, Tainan, Taiwan
| | - Chia-Ming Chang
- Department of Geriatrics and Gerontology, National Cheng Kung University Hospital, College of medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Geriatrics and Gerontology, School of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Ching Yang
- Department of Geriatrics and Gerontology, National Cheng Kung University Hospital, College of medicine, National Cheng Kung University, Tainan, Taiwan.
- Department of Family Medicine,School of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Zhu J, Zhou Y, Wang G. Cost-Effectiveness of Pharmacist Care in Diabetes Management: A Systematic Review. Diabetes Ther 2024; 15:61-76. [PMID: 37957464 PMCID: PMC10786784 DOI: 10.1007/s13300-023-01505-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
INTRODUCTION In recent years, the role of pharmacists has undergone significant transformation to become more patient-centered and involved in managing chronic diseases. Nonetheless, it remains unclear whether pharmacist involvement in diabetes management is cost-effective. This study aimed to systematically review the cost-effectiveness and reporting quality in comprehensive economic evaluations of pharmacist management compared to standard care in diabetes. METHODS Eligible studies included cost-effectiveness analyses employing pharmacist professional services as the intervention for diabetes. A literature search was conducted in the bibliographic databases Pubmed, Scopus, China National Knowledge Infrastructure (CNKI), and the International Health Technology Assessment (HTA) database from their inception until July 2023. Two independent reviewers performed title, abstract, full-text screening, and data abstraction and assessed the quality of reporting and methodological approaches using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS 2022) checklists. RESULTS Twelve studies were identified with an average research quality score of 19.8, including cost-utility (n = 5) and cost-effectiveness (n = 7) analyses, with only four studies rated as high quality. The efficacy data were derived from randomized controlled trials (n = 7), retrospective studies (n = 2), and published literature sources (n = 2). Half of the included studies were conducted in high-income countries, while the other half was in upper-middle and lower-middle-income countries, respectively. Despite significant variations in the cost of pharmacist intervention, consistent findings demonstrate that pharmacist involvement in diabetes management is more cost-effective or even cost-saving than standard care, primarily attributed to better glycemic control, enhanced patient compliance, and reduced risks of medication-related problems. CONCLUSION This systematic review substantiates that pharmacist involvement in diabetes management is cost-effective compared with standard care. However, the overall quality of reporting needs to be improved, and high-quality evidence is urgently needed to support healthcare decision-making in pharmacy practice.
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Affiliation(s)
- Jiejin Zhu
- Department of Clinical Pharmacy, Hangzhou First People's Hospital, No. 261 Huansha Road, Hangzhou, 310006, Zhejiang, China
| | - Ying Zhou
- Department of Clinical Pharmacy, Hangzhou First People's Hospital, No. 261 Huansha Road, Hangzhou, 310006, Zhejiang, China
| | - Gang Wang
- Department of Clinical Pharmacy, Hangzhou First People's Hospital, No. 261 Huansha Road, Hangzhou, 310006, Zhejiang, China.
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Desse TA, Namara KMC, Yifter H, Manias E. Collaborative practice in type 2 diabetes management in a developing country: A qualitative study of perceptions and attitudes of key stakeholders. J Clin Nurs 2023; 32:8137-8148. [PMID: 37727881 DOI: 10.1111/jocn.16884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/19/2023] [Accepted: 09/07/2023] [Indexed: 09/21/2023]
Abstract
AIMS AND OBJECTIVES To explore collaborative practice and perceptions and attitudes of key stakeholders on collaboration in type 2 diabetes management in a tertiary care setting. BACKGROUND Understanding collaborative practice in diabetes care in developing countries helps to design and provide patient-centred and cost-effective care. DESIGN An exploratory qualitative study. METHODS Interviews were undertaken with 30 patients and 18 health professionals and policymakers. Thematic data analysis was undertaken to explore collaborative practice and examine participant perspectives on collaboration in diabetes management. We compared the findings with D'Amour's Collaboration Framework to determine the level of collaboration. RESULTS Most participants reported a lack of collaborative practice in diabetes management, while they appreciated its importance in improving care. Perceptions varied with respect to what constituted collaborative practice. Three themes were identified: (1) perspectives of key stakeholders on current practice of collaboration; (2) impediments to collaborative practice; (3) strategies to improve collaborative practice. Analyses of the themes using D'Amour's Collaboration Framework indicated a low level of collaboration among physicians, nurses, pharmacists and policymakers, which was attributed to workload and time pressures on health professionals, power dynamics and lack of role clarity of all actors in collaborative action. Participants commented on the need to improve collaboration by establishing strong leadership and governance at different healthcare structure levels, which is committed to coordinating collaboration and developing collaborative frameworks and policies that guide collaborative undertaking. CONCLUSIONS Perceived shortcomings of collaboration were attributed to inadequate resources, power dynamics, a lack of strong team functioning and policies. Participants' positive perceptions provide an opportunity to improve collaborative practice through incorporation of collaborative frameworks and policies. RELEVANCE TO CLINICAL PRACTICE The findings in this study inform development of tailored and patient-centred diabetes care in tertiary care settings in sub-Saharan Africa. REPORTING METHOD The study was reported in accordance with the COREQ checklist. PATIENT OR PUBLIC CONTRIBUTION Patients or the public were not involved in the design, analysis or interpretation of the data in this study. However, patients and healthcare providers participated in pilot interviews, which helped refine the interview guides. The summary of the findings of the study was also discussed with patients and healthcare providers, where they provided feedback.
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Affiliation(s)
- Tigestu Alemu Desse
- Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kevin M C Namara
- Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Warrnambool, Victoria, Australia
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Helen Yifter
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Elizabeth Manias
- Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
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Price E, Shirtcliffe A, Fisher T, Chadwick M, Marra CA. A systematic review of economic evaluations of pharmacist services. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2023; 31:459-471. [PMID: 37543960 DOI: 10.1093/ijpp/riad052] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 07/07/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Challenges to the provision of health care are occurring internationally and are expected to increase in the future, further increasing health spending. As pharmacist roles are evolving and expanding internationally to provide individualised pharmaceutical care it is important to assess the cost-effectiveness of these services. OBJECTIVES To systematically synthesise the international literature regarding published economic evaluations of pharmacy services to assess their cost-effectiveness and clinical outcomes. METHODS A systematic review of economic evaluations of pharmacy services was conducted in MEDLINE, EMBASE, PubMed, Scopus, Web of Science, CINAHL, IPA and online journals with search functions likely to publish economic evaluations of pharmacy services. Data were extracted regarding the interventions, the time horizon, the outcomes and the incremental cost-effectiveness ratio. Studies' quality of reporting was assessed using the Consolidated Health Economic Evaluation Reporting Standard (CHEERS) statement. RESULTS Seventy-five studies were included in the systematic review, including 67 cost-effectiveness analyses, 6 cost-benefit analyses and 2 cost-consequence analyses. Of these, 57 were either dominant or cost-effective using a willingness-to-pay threshold of NZ$46 645 per QALY. A further 11 studies' cost-effectiveness were unable to be evaluated. Interventions considered to be most cost-effective included pharmacist medication reviews, pharmacist adherence strategies and pharmacist management of type 2 diabetes mellitus, hypertension and warfarin/INR monitoring. The quality of reporting of studies differed with no studies reporting all 28 items of the CHEERS statement. CONCLUSIONS There is strong economic evidence to support investment in extended pharmacist services, particularly those focussed on long-term chronic health conditions.
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Affiliation(s)
- Emilia Price
- Division of Health Sciences, School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Andi Shirtcliffe
- Allied Health Office of the Chief Clinical Officers System Performance and Monitoring Ministry of Health, Wellington, New Zealand
| | - Thelma Fisher
- Centre for Pacific Health Information Services, University Library, University of Otago, Dunedin, New Zealand
| | - Martin Chadwick
- Office of the Chief Clinical Officers, Ministry of Health, Wellington, New Zealand
| | - Carlo A Marra
- Division of Health Sciences, School of Pharmacy, University of Otago, Dunedin, New Zealand
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Andersen JD, Jensen MH, Vestergaard P, Jensen V, Hejlesen O, Hangaard S. The multidisciplinary team in diagnosing and treatment of patients
with diabetes and comorbidities: A scoping review. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2023; 13:26335565231165966. [PMID: 36968789 PMCID: PMC10031602 DOI: 10.1177/26335565231165966] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 03/09/2023] [Indexed: 03/24/2023]
Abstract
Background Multidisciplinary Teams (MDTs) has been suggested as an intervention to
overcome some of the complexities experienced by people with diabetes and
comorbidities in terms of diagnosis and treatment. However, evidence
concerning MDTs within the diabetes field remains sparse. Objective This review aims to identify and map available evidence on key
characteristics of MDTs in the context of diagnosis and treatment in people
with diabetes and comorbidities. Methods This review followed the PRISMA-ScR guidelines. Databases PubMed, EMBASE, and
CINAHL were systematically searched for studies assessing any type of MDT
within the context of diagnosis and treatment in adult people (≥ 18 years)
with diabetes and comorbidities/complications. Data extraction included
details on study characteristics, MDT interventions, digital health
solutions, and key findings. Results Overall, 19 studies were included. Generally, the MDTs were characterized by
high heterogeneity. Four overall components characterized the MDTs: Both
medical specialists and healthcare professionals (HCPs) of different team
sizes were represented; interventions spanned elements of medication,
assessment, nutrition, education, self-monitoring, and treatment adjustment;
digital health solutions were integrated in 58% of the studies; MDTs were
carried out in both primary and secondary healthcare settings with varying
frequencies. Generally, the effectiveness of the MDTs was positive across
different outcomes. Conclusions MDTs are characterized by high diversity in their outline yet seem to be
effective and cost-effective in the context of diagnosis and treatment of
people with diabetes and comorbidities. Future research should investigate
the cross-sectorial collaboration to reduce care fragmentation and enhance
care coordination.
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Affiliation(s)
- Jonas Dahl Andersen
- Department of Health Science and
Technology, Faculty of Medicine, Aalborg
University, Aalborg, Denmark
- Steno Diabetes Center North
Denmark, Aalborg, Denmark
- Jonas Dahl Andersen, Department of Health
Science and Technology, Aalborg University, Selma Lagerløfs Vej 249, DK-9260
Gistrup, Denmark.
| | - Morten Hasselstrøm Jensen
- Department of Health Science and
Technology, Faculty of Medicine, Aalborg
University, Aalborg, Denmark
- Steno Diabetes Center North
Denmark, Aalborg, Denmark
| | - Peter Vestergaard
- Department of Health Science and
Technology, Faculty of Medicine, Aalborg
University, Aalborg, Denmark
- Steno Diabetes Center North
Denmark, Aalborg, Denmark
- Department of Endocrinology and
Clinical Medicine, Aalborg
University Hospital,
Aalborg, Denmark
| | - Vigga Jensen
- Steno Diabetes Center North
Denmark, Aalborg, Denmark
| | - Ole Hejlesen
- Department of Health Science and
Technology, Faculty of Medicine, Aalborg
University, Aalborg, Denmark
| | - Stine Hangaard
- Department of Health Science and
Technology, Faculty of Medicine, Aalborg
University, Aalborg, Denmark
- Steno Diabetes Center North
Denmark, Aalborg, Denmark
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Dahal PK, Rawal LB, Mahumud RA, Paudel G, Sugishita T, Vandelanotte C. Economic Evaluation of Health Behavior Interventions to Prevent and Manage Type 2 Diabetes Mellitus in Asia: A Systematic Review of Randomized Controlled Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10799. [PMID: 36078539 PMCID: PMC9518060 DOI: 10.3390/ijerph191710799] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 06/15/2023]
Abstract
Health behavior interventions implemented in Asian countries often lack economic evaluations that effectively address the problems of type 2 diabetes mellitus. This review systematically assessed the existing literature on economic evaluation of health behavior interventions to prevent and manage type 2 diabetes mellitus for people living in Asian countries. Eligible studies were identified through a search of six bibliographic databases, namely, PubMed, Scopus, Public Health Database by ProQuest, Cumulative Index to Nursing and Allied Health Literature Complete, Web of Science, and Google Scholar. Randomized controlled trials of health behavior interventions and studies published in the English language from January 2000 to May 2022 were included in the review. The search yielded 3867 records, of which 11 studies were included in the review. All included studies concluded that health behavior interventions were cost-effective. Eight of these studies undertook an evaluation from a health system perspective, two studies used both societal and health system perspectives, and one study utilized a societal and multi-payer perspective. This review identified the time horizon, direct and indirect medical costs, and discount rates as the most important considerations in determining cost effectiveness. These findings have implications in extending health behavior interventions to prevent and manage type 2 diabetes mellitus in low-resource settings, and are likely to yield the most promising outcomes for people with type 2 diabetes mellitus.
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Affiliation(s)
- Padam Kanta Dahal
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney, NSW 2000, Australia or
- Appleton Institute, Physical Activity Research Group, Central Queensland University, Rockhampton, QLD 4702, Australia
| | - Lal B. Rawal
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney, NSW 2000, Australia or
- Appleton Institute, Physical Activity Research Group, Central Queensland University, Rockhampton, QLD 4702, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Sydney, NSW 2751, Australia
| | - Rashidul Alam Mahumud
- NHRMC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Grish Paudel
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney, NSW 2000, Australia or
- Appleton Institute, Physical Activity Research Group, Central Queensland University, Rockhampton, QLD 4702, Australia
| | - Tomohiko Sugishita
- Section of Global Health, Division of Public Health, Department of Public Health, Tokyo Women’s Medical University, Tokyo 162-8666, Japan
| | - Corneel Vandelanotte
- Appleton Institute, Physical Activity Research Group, Central Queensland University, Rockhampton, QLD 4702, Australia
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Bezerra HS, Brasileiro Costa AL, Pinto RS, Ernesto de Resende P, Martins de Freitas GR. Economic impact of pharmaceutical services on polymedicated patients: A systematic review. Res Social Adm Pharm 2022; 18:3492-3500. [DOI: 10.1016/j.sapharm.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 10/27/2021] [Accepted: 03/09/2022] [Indexed: 11/16/2022]
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Keller EJ, Nixon K, Oladini L, Chrisman HB, Chaudhari A, Milad MP, Vogelzang RL. The power of proximity: Effects of a multidisciplinary fibroid clinic on inter-specialty perceptions and practice patterns. PLoS One 2022; 17:e0263058. [PMID: 35077500 PMCID: PMC8789146 DOI: 10.1371/journal.pone.0263058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 01/11/2022] [Indexed: 11/25/2022] Open
Abstract
Background Multidisciplinary collaboration has generally been shown to have positive effects on healthcare but can be difficult to facilitate. This study assessed the effects of a multidisciplinary fibroid clinic on practice patterns and clinician perceptions to better understand drivers of interspecialty collaboration. Materials and methods Annual rates of hysterectomies, myomectomies, and uterine fibroid embolizations (UFEs) performed in an urban healthcare system were collected from 2012–2019. Rates of each procedure were compared over time before and after launching a multidisciplinary fibroid clinic at the academic medical center. Referral rates were also compared. The gynecologists and interventional radiologists (IRs) involved in the clinic were interviewed 2 years prior to and after the clinic launch about their approaches to fibroids and perceptions of others who treat this condition. A phenomenological approach was used to identify and compare themes within the interviews by two researchers with excellent inter-rater agreement (κ = 0.80). Results and discussion Annual rates of fibroid procedures increased over time (p<0.01) but the relative number of UFEs decreased (p = 0.01). UFE referrals by the clinic gynecologists significantly increased as did the number of combined fibroid procedures (p<0.01). However, the rates of one fibroid procedure relative to others were not different between the clinic and rest of the healthcare system (p = 0.55). Specialty-specific perceptions of fibroid treatments and inter-specialty dynamics did not change. Despite this, clinicians unanimously perceived the clinic and post-clinic practice patterns as positive and distinct from their previous work and relationships between gynecology and IR elsewhere. Limitations of this study included its single clinic design and potential confounder of differences in advertising pre- versus post-clinic. Conclusion Creating the right practice environment may be more important for fostering inter-specialty collaboration and work satisfaction than shared mental models or procedural volumes in certain practice settings.
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Affiliation(s)
- Eric J. Keller
- Division of Interventional Radiology, Stanford University, Stanford, CA, United States of America
- * E-mail:
| | - Kayla Nixon
- Division of Minimally Invasive Gynecologic Surgery, Northwestern University, Chicago, IL, United States of America
| | - Lola Oladini
- Division of Interventional Radiology, Stanford University, Stanford, CA, United States of America
| | - Howard B. Chrisman
- Division of Interventional Radiology, Northwestern University, Chicago, IL, United States of America
| | - Angela Chaudhari
- Division of Minimally Invasive Gynecologic Surgery, Northwestern University, Chicago, IL, United States of America
| | - Magdy P. Milad
- Division of Minimally Invasive Gynecologic Surgery, Northwestern University, Chicago, IL, United States of America
| | - Robert L. Vogelzang
- Division of Interventional Radiology, Northwestern University, Chicago, IL, United States of America
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Henriksen DP, Ennis ZN, Panou V, Hangaard J, Jensen PB, Johansson SL, Nagarajah S, Poulsen MK, Rothmann MJ, Schousboe K, Bugge SJ, Jessen LB, Schneider IR, Olsen Zwisler AD, Højlund K, Damkier P. Physician-led in-hospital multidisciplinary team conferences with multiple medical specialities present - A scoping review. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2022; 12:26335565221141745. [PMID: 36518524 PMCID: PMC9742578 DOI: 10.1177/26335565221141745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/09/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Multidisciplinary Team Conferences (MDTs) are complex interventions in the modern healthcare system and they promote a model of coordinated patient care and management. However, MDTs within chronic diseases are poorly defined. Therefore, the aim of this scoping review was to summarise the current literature on physician-led in-hospital MDTs in chronic non-malignant diseases. METHOD Following the PRISMA-ScR guideline for scoping reviews, a search on MDT interventions in adult patients, with three or more medical specialties represented, was performed. RESULTS We identified 2790 studies, from which 8 studies were included. The majority of studies were non-randomised and focused on a single disease entity such as infective endocarditis, atrial fibrillation, IgG4-related disease, or arterial and venous thrombosis. The main reason for referral was confirmation or establishment of a diagnosis, and the MDT members were primarily from medical specialties gathered especially for the MDT. Outcomes of the included studies were grouped into process indicators and outcome indicators. Process indicators included changes in diagnostic confirmation as well as therapeutic strategy and management. All studies reporting process indicators demonstrated significant changes before and after the MDT. CONCLUSION MDTs within chronic diseases appeared highly heterogeneous with respect to structure, reasons for referral, and choice of outcomes. While process indicators, such as change in diagnosis, and treatment management/plan seem improved, such have not been demonstrated through outcome indicators.
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Affiliation(s)
- Daniel Pilsgaard Henriksen
- Department of Clinical Pharmacology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Zandra Nymand Ennis
- Department of Clinical Pharmacology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Vasiliki Panou
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Jørgen Hangaard
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Per Bruno Jensen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Nephrology, Odense University Hospital, Odense, Denmark
| | - Sofie Lock Johansson
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Subagini Nagarajah
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Nephrology, Odense University Hospital, Odense, Denmark
| | - Marianne Kjær Poulsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Mette Juel Rothmann
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Karoline Schousboe
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Stine Jorstad Bugge
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Ida Ransby Schneider
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Ann Dorthe Olsen Zwisler
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
| | - Kurt Højlund
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Per Damkier
- Department of Clinical Pharmacology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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11
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Desse TA, Vakil K, Mc Namara K, Manias E. Impact of clinical pharmacy interventions on health and economic outcomes in type 2 diabetes: A systematic review and meta-analysis. Diabet Med 2021; 38:e14526. [PMID: 33470480 DOI: 10.1111/dme.14526] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/17/2020] [Accepted: 01/18/2021] [Indexed: 12/18/2022]
Abstract
AIM To examine the effectiveness of clinical pharmacy interventions on health and economic outcomes of people with type 2 diabetes in hospital settings. METHODS We searched MEDLINE, EMBASE, PsycInfo, CINAHL, COCHRANE Library and citations and reference lists of key articles. We included randomized and non-randomized controlled trials, cohort and controlled before-after studies. Primary outcomes were glycosylated haemoglobin (HbA1c ), all-cause mortality, major cardiovascular events, adverse events (AEs), health-related quality of life and economic outcomes. RESULTS We retrieved 11,853 studies, of which 44 studies were included in the review (n = 8623). We included 29 randomized controlled studies in the meta-analyses (n = 4055). Clinical pharmacy interventions significantly reduced HbA1c levels compared to usual care (standardized mean difference: -0.52, p < 0.001). The interventions significantly reduced AEs compared to usual care. No studies were reported on the effectiveness of clinical pharmacy interventions on major cardiovascular events. In one study that examined the impact of clinical pharmacy interventions on all-cause mortality, a non-significant reduction was observed compared with usual care. There was significant improvement in quality of life and significant reduction in costs of type 2 diabetes care compared to usual care. CONCLUSIONS Clinical pharmacy interventions were effective in improving glycaemic control, quality of life and reducing the rate of AEs and costs of type 2 diabetes care.
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Affiliation(s)
- Tigestu A Desse
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Burwood, Vic., Australia
| | - Krishna Vakil
- School of Medicine, Faculty of Health, Deakin University, Burwood, Vic., Australia
| | - Kevin Mc Namara
- School of Medicine, Faculty of Health, Deakin University, Burwood, Vic., Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Burwood, Vic., Australia
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12
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Niu XD, Chi JT, Guo JB, Ruan HH, Zhang J, Tao HX, Wang YH. Effects of nurse-led web-based interventions on people with type 2 diabetes mellitus: A systematic review and meta-analysis. J Telemed Telecare 2021; 27:269-279. [PMID: 33966522 DOI: 10.1177/1357633x211010019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Diabetes mellitus is an expanding global health problem. Currently, the home management of diabetes is mainly led by a multidisciplinary team based on telemedicine. However, the role nurses play in it remains inconclusive. This study aimed to investigate the effectiveness of nurse-led web-based intervention on glycated haemoglobin, blood pressure and lipid profile in patients with type 2 diabetes. METHODS An exhaustive systematic literature search was undertaken using the following databases: PubMed, Web of Science, Embase, The Cochrane Central Register of Controlled Trials and CINAHL. Two investigators independently extracted data and assessed the quality of the studies by examining the risk of bias and using Modified Jadad Score system. We conducted a meta-analysis of randomized controlled trials that had been published from inception to July 2020, using Review Manager 5.3. RESULTS Eleven randomized controlled trials were selected that included 2063 participants. Meta-analyses results indicated significant effects on not only glycated haemoglobin (pooled mean difference (MD) = -0.40, 95% confidence interval (CI): -0.5 to -0.26, p < 0.00001), but also on systolic blood pressure (pooled MD = -1.91, 95% CI: -3.73 to -0.09, p = 0.04) and low density lipoprotein (pooled standardized MD = -0.29, 95% CI: -0.44 to -0.15, p < 0.0001). There were no effects of nurse-led web-based intervention on fasting blood glucose, diastolic blood pressure, high density lipoprotein, body mass index and triglycerides. DISCUSSION Nurse-led web-based intervention is a promising way to complement routine clinical care. However, the specific intervention content and intervention media still need to carry out large-scale well-designed randomized controlled trials. Systematic review registration: PROSPERO CRD 42020204565.
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Affiliation(s)
| | | | - Jing-Bo Guo
- School of Nursing, Lanzhou University, China
| | | | - Jing Zhang
- School of Nursing, Lanzhou University, China
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13
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Lagisetty P, Smith A, Antoku D, Winter S, Smith M, Jannausch M, Mi Choe H, Bohnert ASB, Heisler M. A physician-pharmacist collaborative care model to prevent opioid misuse. Am J Health Syst Pharm 2021; 77:771-780. [PMID: 32315401 DOI: 10.1093/ajhp/zxaa060] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Clinical pharmacists in primary care clinics can potentially help manage chronic pain and opioid prescriptions by providing services similar to those provided within their scope of practice to patients with diabetes and hypertension. We evaluated the feasibility and acceptability of a pharmacist-physician collaborative care model for patients with chronic pain. METHODS The program consisted of an in-person pharmacist consultation and optional follow-up visits over 4 months in 2 primary care practices. Eligible patients had chronic pain and a long-term prescription for opioids or buprenorphine or were referred by their primary care physician (PCP). Pharmacist recommendations were communicated to PCPs via the electronic medical record (EMR) and direct communication. Mixed-methods evaluation included baseline and follow-up surveys with patients, EMR review of opioid-related clinical encounters, and provider interviews. RESULTS Between January and October 2018, 47 of the 182 eligible patients enrolled, with 46 completing all follow-up; 43 patients (91%) had received opioids over the past 6 months. The pharmacist recommended adding or switching to a nonopioid pain medication for 30 patients, switching to buprenorphine for pain and complex persistent opioid dependence for 20 patients, and tapering opioids for 3 patients. All physicians found the intervention acceptable but wanted more guidance on prescribing buprenorphine for pain. Most patients found the intervention helpful, but some reported a lack of physician follow-up on recommended changes. CONCLUSION The study demonstrated that comanagement of patients with chronic pain is feasible and acceptable. Policy changes to increase pharmacists' authority to prescribe may increase physician willingness and confidence to carry out opioid tapers and prescribe buprenorphine for pain.
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Affiliation(s)
- Pooja Lagisetty
- Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, and Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Alex Smith
- University of Michigan College of Pharmacy, Ann Arbor, MI
| | - Derek Antoku
- Department of Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Suzanne Winter
- Department of Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Michael Smith
- University of Michigan College of Pharmacy, Ann Arbor, MI
| | - Mary Jannausch
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
| | - Hae Mi Choe
- University of Michigan College of Pharmacy, Ann Arbor, MI
| | - Amy S B Bohnert
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, and Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Michele Heisler
- Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, and Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
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14
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Mousa R, Hammad E. Cost-effectiveness of pharmacist-led care versus usual care in type 2 diabetic Jordanians: a Markov modeling of cardiovascular diseases prevention. Expert Rev Pharmacoecon Outcomes Res 2020; 21:1069-1079. [PMID: 33213221 DOI: 10.1080/14737167.2021.1838900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cardiovascular diseases (CVDs) are responsible for one third of global deaths and the main cause of death among Jordanians. Pharmacist-led care was outlined previously as a cost-effective approach in the management of chronic illness; however, this is not well studied in low to middle-income countries. AIM AND OBJECTIVES To assess the cost-effectiveness of pharmacist-led care versus usual care in preventing CVDs in Type 2 Diabetes Mellitus (T2DM). METHOD A Markov model of one-year cycle length and 10-year time horizon was constructed to simulate 10-year CVD events, mortality, and costs for two hypothetical cohorts; usual care and pharmacist-led care, respectively, of Jordanian patients suffering from T2DM. Public health provider perspective was adopted. Outcomes examined were incremental costs, LYGs, and incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analysis (PSA) assessed the robustness of the results. RESULT The pharmacist-led care generated an additional 0.3 LYG/patient at an additional cost of JD1,238.78 (US$1,747.24) comparing to the usual care in the 10-year base-case analysis. Deterministic and PSA supported the robustness of base-case findings, indicating that pharmacist-led care is cost-effective. CONCLUSION The findings outline long-term clinical and economic benefits of expanding clinical pharmacist's roles in direct patient care services.
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Affiliation(s)
- Rimal Mousa
- Department of Biopharmaceutics and Clinical Pharmacy, University of Jordan, Amman, Jordan
| | - Eman Hammad
- Department of Biopharmaceutics and Clinical Pharmacy, University of Jordan, Amman, Jordan
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15
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Rocks S, Berntson D, Gil-Salmerón A, Kadu M, Ehrenberg N, Stein V, Tsiachristas A. Cost and effects of integrated care: a systematic literature review and meta-analysis. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:1211-1221. [PMID: 32632820 PMCID: PMC7561551 DOI: 10.1007/s10198-020-01217-5] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 06/30/2020] [Indexed: 05/26/2023]
Abstract
BACKGROUND Health and care services are becoming increasingly strained and healthcare authorities worldwide are investing in integrated care in the hope of delivering higher-quality services while containing costs. The cost-effectiveness of integrated care, however, remains unclear. This systematic review and meta-analysis aims to appraise current economic evaluations of integrated care and assesses the impact on outcomes and costs. METHODS CINAHL, DARE, EMBASE, Medline/PubMed, NHS EED, OECD Library, Scopus, Web of Science, and WHOLIS databases from inception to 31 December 2019 were searched to identify studies assessing the cost-effectiveness of integrated care. Study quality was assessed using an adapted CHEERS checklist and used as weight in a random-effects meta-analysis to estimate mean cost and mean outcomes of integrated care. RESULTS Selected studies achieved a relatively low average quality score of 65.0% (± 18.7%). Overall meta-analyses from 34 studies showed a significant decrease in costs (0.94; CI 0.90-0.99) and a statistically significant improvement in outcomes (1.06; CI 1.05-1.08) associated with integrated care compared to the control. There is substantial heterogeneity in both costs and outcomes across subgroups. Results were significant in studies lasting over 12 months (12 studies), with both a decrease in cost (0.87; CI 0.80-0.94) and improvement in outcomes (1.15; 95% CI 1.11-1.18) for integrated care interventions; whereas, these associations were not significant in studies with follow-up less than a year. CONCLUSION Our findings suggest that integrated care is likely to reduce cost and improve outcome. However, existing evidence varies largely and is of moderate quality. Future economic evaluation should target methodological issues to aid policy decisions with more robust evidence on the cost-effectiveness of integrated care.
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Affiliation(s)
- Stephen Rocks
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Daniela Berntson
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Mudathira Kadu
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | - Viktoria Stein
- International Foundation for Integrated Care, Oxford, UK
| | - Apostolos Tsiachristas
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
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16
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Sosa-Rubí SG, Contreras-Loya D, Pedraza-Arizmendi D, Chivardi-Moreno C, Alarid-Escudero F, López-Ridaura R, Servan-Mori E, Molina-Cuevas V, Casales-Hernández G, Espinosa-López C, González-Roldán JF, Silva-Tinoco R, Seiglie J, Gómez-Dantés O. Cost-effectiveness analysis of a multidisciplinary health-care model for patients with type-2 diabetes implemented in the public sector in Mexico: A quasi-experimental, retrospective evaluation. Diabetes Res Clin Pract 2020; 167:108336. [PMID: 32755762 PMCID: PMC8010712 DOI: 10.1016/j.diabres.2020.108336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/02/2020] [Accepted: 07/16/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE In 2007, the Ministry of Health (MoH) in Mexico implemented a multidisciplinary health-care model (MHC) for patients with type-2 diabetes (T2D), which has proven more effective in controlling this condition than the conventional health-care model (CHC). RESEARCH DESIGN AND METHODS We compared the cost-effectiveness of the MHC vs. the CHC for patients with T2D using a quasi-experimental, retrospective design. Epidemiologic and cost data were obtained from a randomly selected sample of health-care units, using medical records as well as patient- and facility-level data. We modelled the cost-effectiveness of the MHC at one, 10 and 20 years using a simulation model. RESULTS The average cumulative costs per patient at 20 years were US$4,225 for the MHC and US$4,399 for the CHC. With a willingness to pay one gross domestic product (GDP) per capita per quality-adjusted life year (QALY) (US$8,910), the incremental net benefits per patient were US$1,450 and US$3,737 at 10 and 20 years, respectively. The MHC was cost-effective from the third year onward; however, increasing coverage to 500 patients per year rendered it cost-effective at year one. CONCLUSIONS The MHC is cost-effective at 10 and 20 years. Cost-effectiveness can be achieved in the short term by increasing MHC coverage.
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Affiliation(s)
- S G Sosa-Rubí
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health (INSP).
| | | | - D Pedraza-Arizmendi
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health (INSP)
| | - C Chivardi-Moreno
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health (INSP)
| | - F Alarid-Escudero
- Division of Public Administration, Center for Research and Teaching in Economics, Aguascalientes, Mexico
| | - R López-Ridaura
- National Center for Disease Prevention and Control Programs (CENAPRECE), Ministry of Health, Mexico
| | - E Servan-Mori
- Health System Research Center, National Institute of Public Health (INSP)
| | - V Molina-Cuevas
- Pan American Health Organization, Mexico City Office, Mexico
| | - G Casales-Hernández
- National Center for Disease Prevention and Control Programs (CENAPRECE), Ministry of Health, Mexico
| | | | | | - R Silva-Tinoco
- Specialized Clinic in Diabetes Management, Mexico City-Iztapalapa, Ministry of Health/ Ministry of Health in Mexico City
| | - J Seiglie
- Diabetes Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA
| | - O Gómez-Dantés
- Health System Research Center, National Institute of Public Health (INSP)
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