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Shalash A, Zolezzi M. The evolving role of pharmacists in depression care: a scoping review. Int J Clin Pharm 2024:10.1007/s11096-024-01759-1. [PMID: 39007991 DOI: 10.1007/s11096-024-01759-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 05/22/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Worldwide, depression is known to contribute significantly to the global burden of disease. Considering pharmacists are among the most approachable healthcare providers, they are well-placed to assist people with depression achieve positive treatment outcomes. AIM The primary aim was to examine the evidence regarding pharmacists' roles in interventions, outcomes, and barriers to implementation within depression care globally, with the secondary aim focusing on the Arab region. METHOD A scoping review was conducted according to the PRISMA-ScR extension guidelines and the Joanna Briggs Institute framework, using Scopus, Cochrane, ProQuest, and Medline databases for studies worldwide and within the Arab region (22 Arab-league countries). Article selection, along with data extraction, analysis, and narrative synthesis were performed independently by two reviewers. Discrepancies were resolved by consensus. RESULTS Forty studies reporting various roles and services provided by pharmacists in depression management were included. Most articles (24) described studies on pharmacist-led specific/single interventions/management strategies, and 16 described studies in which pharmacists provided comprehensive or team-based services. The majority of studies reported positive impact on patient outcomes. In accordance with the secondary aim, only three studies assessed various pharmacists' services for people with depression in the Arab region. Barriers to effective depression-related care included time constraints and training needs. CONCLUSION This scoping review supports the expanding role of pharmacists in depression management. The interventions, impact, challenges, and research gaps identified serve as preliminary evidence for advocating for an expanded pharmacists' scope of practice in mental health, both globally and in the Arab region.
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Affiliation(s)
- Ala' Shalash
- Clinical Pharmacy Department, Lehbi Renal Care, Riyadh, Kingdom of Saudi Arabia
| | - Monica Zolezzi
- Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar.
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2
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Tonin FS, Aznar-Lou I, Pontinha VM, Pontarolo R, Fernandez-Llimos F. Principles of pharmacoeconomic analysis: the case of pharmacist-led interventions. Pharm Pract (Granada) 2021; 19:2302. [PMID: 33727994 PMCID: PMC7939117 DOI: 10.18549/pharmpract.2021.1.2302] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In the past years, several factors such as evidence-based healthcare culture, quality-linked incentives, and patient-centered actions, associated with an important increase of financial constraints and pressures on healthcare budgets, resulted in a growing interest by policy-makers in enlarging pharmacists' roles in care. Numerous studies have demonstrated positive therapeutic outcomes associated with pharmaceutical services in a wide array of diseases. Yet, the evidence of the economic impact of the pharmacist in decreasing total health expenditures, unnecessary care, and societal costs relies on well-performed, reliable, and transparent economic evaluations, which are scarce. Pharmacoeconomics is a branch of health economics that usually focuses on balancing the costs and benefits of an intervention towards the use of limited resources, aiming at maximizing value to patients, healthcare payers and society through data driven decision making. These decisions can be guide by a health technology assessment (HTA) process that inform governmental players about medical, social, and economic implications of development, diffusion, and use of health technologies - including clinical pharmacy interventions. This paper aims to provide an overview of the important concepts in costing in healthcare, including studies classification according to the type of analysis method (e.g. budget-impact analysis, cost-minimization analysis, cost-effectiveness analysis, cost-utility analysis), types of costs (e.g. direct, indirect and intangible costs) and outcomes (e.g. events prevented, quality adjusted life year - QALY, disability adjusted life year - DALY). Other key components of an economic evaluation such as the models' perspective, time horizon, modelling approaches (e.g. decision trees or simulation models as the Markov model) and sensitivity analysis are also briefly covered. Finally, we discuss the methodological issues for the identification, measurement and valuation of costs and benefits of pharmacy services, and suggest some recommendations for future studies, including the use of Value of Assessment Frameworks.
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Affiliation(s)
- Fernanda S Tonin
- Pharmaceutical Sciences Postgraduate Program, Federal University of Paraná . Curitiba ( Brazil ).
| | - Ignacio Aznar-Lou
- Research and Development Unit, Sant Joan de Déu Research Institute . Barcelona, ( Spain ).
| | - Vasco M Pontinha
- Department of Pharmacotherapy and Outcomes Science, Center for Pharmacy Practice Innovation, School of Pharmacy, Virginia Commonwealth University . Richmond, VA ( United States ).
| | - Roberto Pontarolo
- Department of Pharmacy, Federal University of Paraná . Curitiba ( Brazil ).
| | - Fernando Fernandez-Llimos
- Center for Health Technology and Services Research (CINTESIS), Laboratory of Pharmacology, Faculty of Pharmacy, University of Porto . Porto ( Portugal ).
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3
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García-Pérez L, Linertová R, Serrano-Pérez P, Trujillo-Martín M, Rodríguez-Rodríguez L, Valcárcel-Nazco C, Del Pino-Sedeño T. Interventions to improve medication adherence in mental health: the update of a systematic review of cost-effectiveness. Int J Psychiatry Clin Pract 2020; 24:416-427. [PMID: 32609024 DOI: 10.1080/13651501.2020.1782434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Medication non-adherence in mental health problems has social and economic costs. The objective of the study was to review the cost-effectiveness of interventions to enhance medication adherence in patients with mental health problems. METHODS The update of a previous systematic review was performed. Databases were searched in June 2019: MEDLINE, PSYCINFO, EMBASE, CINAHL, CRD, WOS. Cost-effectiveness studies comparing an intervention to improve the medication adherence with other interventions/usual care in adults with mental health problems were included. Data were extracted, methodological quality of the studies was assessed and a narrative synthesis was performed. RESULTS Nine studies were included in the review. The interventions that showed medication adherence increase were: a financial incentive when depot injection was taken by patients with psychotic disorders, a value-based benefit design policy including copayment and counselling in a company setting, and a medication treatment decision supported by a pharmacogenetic test. The other studies (coaching by pharmacists; a psychological and educational intervention at health care centres) did not find differences between groups. No study found cost differences between alternatives. CONCLUSIONS Interventions to improve medication adherence in adults with mental health problems could be cost-effective, especially those based on financial incentives, although more research is needed. KEYPOINTS There are several types of interventions designed to enhance medication adherence in patients with mental health problems. Few of them have demonstrated cost-effectiveness. Two studies found that a financial incentive per depot injection in patients with psychotic disorders improved the medication adherence. Two other studies found improvement in adherence due to two specific interventions: a value-based benefit design policy in a company setting and a pharmacogenetic test supporting the medication treatment decision. No study found differences in costs between the intervention and the comparator. More research is needed to implement cost-effective interventions.
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Affiliation(s)
- Lidia García-Pérez
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), El Rosario, Spain.,Servicio de Evaluación del Servicio Canario de la Salud (SESCS), El Rosario, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Galdakao, Spain.,Centro de Investigaciones Biomédicas de Canarias (CIBICAN), La Laguna, Spain.,Instituto Universitario de Desarrollo Regional (IUDR), Universidad de La Laguna, Spain
| | - Renata Linertová
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), El Rosario, Spain.,Servicio de Evaluación del Servicio Canario de la Salud (SESCS), El Rosario, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Galdakao, Spain.,Centro de Investigaciones Biomédicas de Canarias (CIBICAN), La Laguna, Spain
| | - Pedro Serrano-Pérez
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Trujillo-Martín
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), El Rosario, Spain.,Servicio de Evaluación del Servicio Canario de la Salud (SESCS), El Rosario, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Galdakao, Spain.,Centro de Investigaciones Biomédicas de Canarias (CIBICAN), La Laguna, Spain
| | - Leticia Rodríguez-Rodríguez
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), El Rosario, Spain.,Servicio de Evaluación del Servicio Canario de la Salud (SESCS), El Rosario, Spain
| | - Cristina Valcárcel-Nazco
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), El Rosario, Spain.,Servicio de Evaluación del Servicio Canario de la Salud (SESCS), El Rosario, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Galdakao, Spain.,Centro de Investigaciones Biomédicas de Canarias (CIBICAN), La Laguna, Spain
| | - Tasmania Del Pino-Sedeño
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), El Rosario, Spain.,Servicio de Evaluación del Servicio Canario de la Salud (SESCS), El Rosario, Spain
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4
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Duevel JA, Hasemann L, Peña-Longobardo LM, Rodríguez-Sánchez B, Aranda-Reneo I, Oliva-Moreno J, López-Bastida J, Greiner W. Considering the societal perspective in economic evaluations: a systematic review in the case of depression. HEALTH ECONOMICS REVIEW 2020; 10:32. [PMID: 32964372 PMCID: PMC7510122 DOI: 10.1186/s13561-020-00288-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/07/2020] [Indexed: 05/27/2023]
Abstract
BACKGROUND Depressive disorders are associated with a high burden of disease. However, due to the burden posed by the disease on not only the sufferers, but also on their relatives, there is an ongoing debate about which costs to include and, hence, which perspective should be applied. Therefore, the aim of this paper was to examine whether the change between healthcare payer and societal perspective leads to different conclusions of cost-utility analyses in the case of depression. METHODS A systematic literature search was conducted to identify economic evaluations of interventions in depression, launched on Medline and the Cost-Effectiveness Registry of the Tufts University using a ten-year time horizon (2008-2018). In a two-stepped screening process, cost-utility studies were selected by means of specified inclusion and exclusion criteria. Subsequently, relevant findings was extracted and, if not fully stated, calculated by the authors of this work. RESULTS Overall, 53 articles with 92 complete economic evaluations, reporting costs from healthcare payer/provider and societal perspective, were identified. More precisely, 22 estimations (24%) changed their results regarding the cost-effectiveness quadrant when the societal perspective was included. Furthermore, 5% of the ICURs resulted in cost-effectiveness regarding the chosen threshold (2% of them became dominant) when societal costs were included. However, another four estimations (4%) showed the opposite result: these interventions were no longer cost-effective after the inclusion of societal costs. CONCLUSIONS Summarising the disparities in results and applied methods, the results show that societal costs might alter the conclusions in cost-utility analyses. Hence, the relevance of the perspectives chosen should be taken into account when carrying out an economic evaluation. This systematic review demonstrates that the results of economic evaluations can be affected by different methods available for estimating non-healthcare costs.
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Affiliation(s)
- Juliane Andrea Duevel
- AG 5 - Department of Health Economics and Health Care Management, Bielefeld University, School of Public Health, Universitaetsstrasse 25, 33615, Bielefeld, Germany.
| | - Lena Hasemann
- AG 5 - Department of Health Economics and Health Care Management, Bielefeld University, School of Public Health, Universitaetsstrasse 25, 33615, Bielefeld, Germany
| | - Luz María Peña-Longobardo
- Faculty of Law and Social Sciences, Economic Analysis Department, Research Group in Economics and Health, University of Castilla-La Mancha, Cobertizo San Pedro Mártir, S/N, 45002, Toledo, Spain
| | - Beatriz Rodríguez-Sánchez
- Faculty of Law and Social Sciences, Economic Analysis Department, Research Group in Economics and Health, University of Castilla-La Mancha, Cobertizo San Pedro Mártir, S/N, 45002, Toledo, Spain
- Faculty of Technology and Science, University Camilo José Cela, Urb. Villafranca del Castillo, Calle Castillo de Alarcón, 49, 28692 Villanueva de la Cañada, Madrid, Spain
| | - Isaac Aranda-Reneo
- Faculty of Social Science, Economic Analysis and Finance Department, Research Group in Economics and Health, University of Castilla-La Mancha, Avda. Real Fábrica s/n, Talavera de la Reina, 45600, Toledo, Spain
| | - Juan Oliva-Moreno
- Faculty of Law and Social Sciences, Economic Analysis Department, Research Group in Economics and Health, University of Castilla-La Mancha, Cobertizo San Pedro Mártir, S/N, 45002, Toledo, Spain
| | - Julio López-Bastida
- Faculty of Health Science, Research Group in Economics and Health, University of Castilla-La Mancha, Av. Real Fábrica de Sedas, s/n, Talavera de la Reina, 45600, Toledo, Spain
| | - Wolfgang Greiner
- AG 5 - Department of Health Economics and Health Care Management, Bielefeld University, School of Public Health, Universitaetsstrasse 25, 33615, Bielefeld, Germany
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Kamusheva M, Ignatova D, Golda A, Skowron A. The Potential Role of the Pharmacist in Supporting Patients with Depression - A Literature-Based Point of View. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2020; 9:49-63. [PMID: 32161716 PMCID: PMC7049755 DOI: 10.2147/iprp.s239672] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 01/24/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE The current article is aimed at identifying the best practice for counseling around depression in community and outpatient pharmacies, resulting in a draft guideline, proposing key steps and an algorithm for integration of community pharmacists into care for patients with depression. METHODS A literature review was performed followed by a detailed analysis, for the purpose of creation a short draft document used as a basis for creation of a guideline for pharmaceutical care for patients with depression. The technological scheme PRISMA flow diagram was applied. The paper is based on current knowledge, taking into consideration already published articles, guidelines, and recommendations about pharmaceutical care for patients with depression, giving a basis for further studies. RESULTS This paper includes two main sections: 1) depression - a short description of the main symptoms, risk factors and pharmacotherapy guidelines available in Bulgaria important for the purposes of ensuring qualitative community-based pharmaceutical care; and 2) the pharmacists' role in providing high-quality care - the main aspects of pharmaceutical care for patients with depression with specific examples. CONCLUSION The involvement of pharmacists in supporting depressive patients is crucial taking into account the specific characteristics of the pharmacological treatment: delayed onset of clinical results, risks in case of sudden pharmacotherapy abruption without physician consultation, multiple adverse drug reactions and drug-drug, drug-food and drug-alcohol interactions, etc. The current article could also be used as an initial document for creating a methodological guideline for providing pharmaceutical care services for patients with depression.
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Affiliation(s)
- Maria Kamusheva
- Department of “Organization and Economics of Pharmacy”, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Desislava Ignatova
- Department of “Psychiatry and Clinical Psychology”, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Anna Golda
- Department of Social Pharmacy, Faculty of Pharmacy, Jagiellonian University MC, Krakow, Poland
| | - Agnieszka Skowron
- Department of Social Pharmacy, Faculty of Pharmacy, Jagiellonian University MC, Krakow, Poland
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6
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Brown JVE, Walton N, Meader N, Todd A, Webster LAD, Steele R, Sampson SJ, Churchill R, McMillan D, Gilbody S, Ekers D. Pharmacy-based management for depression in adults. Cochrane Database Syst Rev 2019; 12:CD013299. [PMID: 31868236 PMCID: PMC6927244 DOI: 10.1002/14651858.cd013299.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND It is common for peoples not to take antidepressant medication as prescribed, with around 50% of people likely to prematurely discontinue taking their medication after six months. Community pharmacists may be well placed to have a role in antidepressant management because of their unique pharmacotherapeutic knowledge and ease of access for people. Pharmacists are in an ideal position to offer proactive interventions to people with depression or depressive symptoms. However, the effectiveness and acceptability of existing pharmacist-based interventions is not yet well understood. The degree to which a pharmacy-based management approach might be beneficial, acceptable to people, and effective as part of the overall management for those with depression is, to date, unclear. A systematic review of randomised controlled trials (RCTs) will help answer these questions and add important knowledge to the currently sparse evidence base. OBJECTIVES To examine the effects of pharmacy-based management interventions compared with active control (e.g. patient information materials or any other active intervention delivered by someone other than the pharmacist or the pharmacy team), waiting list, or treatment as usual (e.g. standard pharmacist advice or antidepressant education, signposting to support available in primary care services, brief medication counselling, and/or (self-)monitoring of medication adherence offered by a healthcare professional outside the pharmacy team) at improving depression outcomes in adults. SEARCH METHODS We searched the Cochrane Common Mental Disorders Controlled Trials Register (CCMD-CTR) to June 2016; the Cochrane Library (Issue 11, 2018); and Ovid MEDLINE, Embase, and PsycINFO to December 2018. We searched theses and dissertation databases and international trial registers for unpublished/ongoing trials. We applied no restrictions on date, language, or publication status to the searches. SELECTION CRITERIA: We included all RCTs and cluster-RCTs where a pharmacy-based intervention was compared with treatment as usual, waiting list, or an alternative intervention in the management of depression in adults over 16 years of age. Eligible studies had to report at least one of the following outcomes at any time point: depression symptom change, acceptability of the intervention, diagnosis of depression, non-adherence to medication, frequency of primary care appointments, quality of life, social functioning, or adverse events. DATA COLLECTION AND ANALYSIS: Two authors independently, and in duplicate, conducted all stages of study selection, data extraction, and quality assessment (including GRADE). We discussed disagreements within the team until we reached consensus. Where data did not allow meta-analyses, we synthesised results narratively. MAIN RESULTS: Twelve studies (2215 participants) met the inclusion criteria and compared pharmacy-based management with treatment as usual. Two studies (291 participants) also included an active control (both used patient information leaflets providing information about the prescribed antidepressant). Neither of these studies reported depression symptom change. A narrative synthesis of results on acceptability of the intervention was inconclusive, with one study reporting better acceptability of pharmacy-based management and the other better acceptability of the active control. One study reported that participants in the pharmacy-based management group had better medication adherence than the control participants. One study reported adverse events with no difference between groups. The studies reported no other outcomes. Meta-analyses comparing pharmacy-based management with treatment as usual showed no evidence of a difference in the effect of the intervention on depression symptom change (dichotomous data; improvement in symptoms yes/no: risk ratio (RR), 0.95, 95% confidence interval (CI) 0.86 to 1.05; 4 RCTs, 475 participants; moderate-quality evidence; continuous data: standard mean difference (SMD) -0.04, 95% CI -0.19 to 0.10; 5 RCTs, 718 participants; high-certainty evidence), or acceptability of the intervention (RR 1.09, 95% CI 0.81 to 1.45; 12 RCTs, 2072 participants; moderate-certainty evidence). The risk of non-adherence was reduced in participants receiving pharmacy-based management (RR 0.73, 95% CI 0.61 to 0.87; 6 RCTs, 911 participants; high-certainty evidence). We were unable to meta-analyse data on diagnosis of depression, frequency of primary care appointments, quality of life, or social functioning. AUTHORS' CONCLUSIONS We found no evidence of a difference between pharmacy-based management for depression in adults compared with treatment as usual in facilitating depression symptom change. Based on numbers of participants leaving the trials early, there may be no difference in acceptability between pharmacy-based management and controls. However, there was uncertainty due to the low-certainty evidence.
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Affiliation(s)
- Jennifer Valeska Elli Brown
- University of YorkCochrane Common Mental DisordersYorkUK
- University of YorkCentre for Reviews and DisseminationYorkUK
| | - Nick Walton
- Newcastle UniversityInstitute of Health and SocietyNewcastle upon TyneUK
| | - Nicholas Meader
- University of YorkCochrane Common Mental DisordersYorkUK
- University of YorkCentre for Reviews and DisseminationYorkUK
| | - Adam Todd
- Newcastle UniversitySchool of PharmacyQueen Victoria RoadNewcastle upon TyneUKNE1 7RU
| | - Lisa AD Webster
- Leeds Trinity UniversitySchool of Social and Health ScienceLeedsUK
| | - Rachel Steele
- Tees, Esk and Wear Valleys NHS Foundation TrustLibrary and Information ServiceDurhamUKDH1 5RD
| | | | - Rachel Churchill
- University of YorkCochrane Common Mental DisordersYorkUK
- University of YorkCentre for Reviews and DisseminationYorkUK
| | - Dean McMillan
- University of YorkMental Health and Addiction Research Group, Department of Health SciencesHeslingtonYork‐ None ‐UKY010 5DD
| | - Simon Gilbody
- University of YorkMental Health and Addiction Research Group, Department of Health SciencesHeslingtonYork‐ None ‐UKY010 5DD
| | - David Ekers
- University of YorkMental Health and Addiction Research Group, Department of Health SciencesHeslingtonYork‐ None ‐UKY010 5DD
- Tees, Esk and Wear Valleys NHS Foundation TrustLanchester Road HospitalDurhamUK
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Sanyal C, Husereau DR. Community-Based Services by Pharmacists: A Systematic Review of Cost-Utility Analyses. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:1450-1457. [PMID: 31806202 DOI: 10.1016/j.jval.2019.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/06/2019] [Accepted: 08/12/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To conduct a systematic review of cost-utility studies of community-based services provided by pharmacists and to examine their reporting and methodological quality. METHODS A comprehensive literature search was performed in February 2019 using a replicable search strategy in bibliographic databases MEDLINE, EMBASE, and the NHS Economic Evaluations Database from their inception onwards. Two reviewers independently screened the literature, abstracted data from full-text articles, and assessed reporting and methodological quality using the Consolidated Health Economic Evaluation Reporting Standards and Quality of Health Economic Studies checklists. RESULTS Twenty studies were included in this review, representing the healthcare systems of the United Kingdom, Spain, France, The Netherlands, Belgium, Italy, Canada, the United States of America, and Brazil. Descriptions of the context in which the studies were done, justification of data sources on patient and process outcomes, choices of model, and generalizability of study findings were often inadequately reported. Seven studies (35%) were deemed of high methodological quality, 11 studies (55%) of fair quality, and 2 studies (10%) of poor quality. In addition, various methodological issues related to the randomized controlled trials and observational studies used to generate effectiveness estimates were identified. CONCLUSIONS In view of the lack of standardized definitions of expanded services, heterogeneity in study objectives, settings, comparators, methodology, outcomes, and the variable quality of these studies, the value of these services (in terms of costs) compared with quality-adjusted survival remains inconclusive.
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Affiliation(s)
| | - Donald R Husereau
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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8
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Rubio-Valera M, Peñarrubia-María MT, Iglesias-González M, Knapp M, McCrone P, Roig M, Sabes-Figuera R, Luciano JV, Mendive JM, Murrugara-Centurión AG, Alonso J, Serrano-Blanco A. Cost-effectiveness of antidepressants versus active monitoring for mild-to-moderate major depressive disorder: a multisite non-randomized-controlled trial in primary care (INFAP study). THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:703-713. [PMID: 30725226 DOI: 10.1007/s10198-019-01034-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 01/31/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the cost-effectiveness of antidepressants vs active monitoring (AM) for patients with mild-moderate major depressive disorder. METHODS This was a 12-month observational prospective controlled trial. Adult patients with a new episode of major depression were invited to participate and assigned to AM or antidepressants according to General Practitioners' clinical judgment and experience. Patients were evaluated at baseline, and 6 and 12-month follow-up. Quality-adjusted life years (QALYs) gained were estimated and used to calculate incremental cost-utility ratios (ICUR) from the healthcare and government perspective. To minimize the bias resulting from non-randomization, a propensity score-based method was used. RESULTS At 6 and 12-month follow-up, ICUR was 2549 €/QALY and 6,142 €/QALY, respectively, in favor of antidepressants. At 6 months, for a willingness to pay (WTP) of 25,000 €/QALY, antidepressants had a probability of 0.89 (healthcare perspective) and 0.81 (government perspective) of being more cost-effective than AM. At 12 months, this probability was 0.86 (healthcare perspective) and 0.73 (government perspective). CONCLUSIONS Incremental cost-utility ratios favor pharmacological treatment as a first-line approach for patients with mild-moderate major depressive disorder. While our results should be interpreted with caution and further real world research is needed, clinical practice guidelines should consider antidepressant therapy for mild-moderate major depressive patients as an alternative to active monitoring in PC.
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Affiliation(s)
- Maria Rubio-Valera
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, C/ Pablo Picasso 12, 08830, Sant Boi de Llobregat, Spain.
- Centre for Biomedical Research in Epidemiology and Public Health, CIBERESP, Madrid, Spain.
- Department Pharmacology, Toxicology and Therapeutic Chemistry, School of Pharmacy, Universitat de Barcelona, Barcelona, Spain.
| | - María Teresa Peñarrubia-María
- Primary Care Health Centre Bartomeu Fabrés Anglada, Servei d'Atenció Primària Delta Llobregat, Àmbit Costa de Ponent, Institut Català de la Salut, Gavà, Spain
| | - Maria Iglesias-González
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, C/ Pablo Picasso 12, 08830, Sant Boi de Llobregat, Spain
| | - Martin Knapp
- Centre for Biomedical Research in Epidemiology and Public Health, CIBERESP, Madrid, Spain
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London, UK
| | - Paul McCrone
- Institute of Psychiatry, King's College London, De Crespigny Park, London, UK
| | - Marta Roig
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, C/ Pablo Picasso 12, 08830, Sant Boi de Llobregat, Spain
- Department Pharmacology, Toxicology and Therapeutic Chemistry, School of Pharmacy, Universitat de Barcelona, Barcelona, Spain
| | - Ramón Sabes-Figuera
- Centre for Biomedical Research in Epidemiology and Public Health, CIBERESP, Madrid, Spain
- Faculty of Economic and Business Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Juan V Luciano
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, C/ Pablo Picasso 12, 08830, Sant Boi de Llobregat, Spain
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Barcelona, Spain
- Open University of Catalonia (UOC), Barcelona, Spain
| | - Juan M Mendive
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Barcelona, Spain
- La Mina Primary Care Centre, Institut Català de la Salut, Sant Adrià de Besós, Barcelona, Spain
| | - Ana Gabriela Murrugara-Centurión
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, C/ Pablo Picasso 12, 08830, Sant Boi de Llobregat, Spain
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Barcelona, Spain
| | - Jordi Alonso
- Centre for Biomedical Research in Epidemiology and Public Health, CIBERESP, Madrid, Spain
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
- Department Experimental and Health Sciences, Pompeu Fabra University (UPF), Barcelona, Spain
| | - Antoni Serrano-Blanco
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, C/ Pablo Picasso 12, 08830, Sant Boi de Llobregat, Spain
- Centre for Biomedical Research in Epidemiology and Public Health, CIBERESP, Madrid, Spain
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9
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Merrill BS, Tak CR, Feehan M, Munger MA. Payers’ Perspectives on Pharmacist-Directed Care in a Community Pharmacy Setting. Ann Pharmacother 2019; 53:916-921. [DOI: 10.1177/1060028019839440] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The United States is spending an increasing share of its national income on health care while American citizens are not receiving the commensurate benefit of longer, healthier lives. Pharmacists are in a position to provide high-quality care; however, a paucity of data exists on payers’ perspectives on insurance reimbursement for pharmacist-provided, community-delivered clinical services. Objective: To understand payers’ perspectives toward pharmacist-provided community-delivered advanced clinical services. Methods: A 15-minute online survey was administered to determine payers’ preferences and attitudes of impact about care being provided in a community pharmacy setting by a pharmacist. Results: The study recruited 50 payers from a diverse set of US organizations. The likelihood for reimbursement for a suite of pharmacist-provided, community-delivered clinical services was likely/very likely (66%), neutral (22%), and unlikely/very unlikely (12%). Pharmacists were viewed positively by payers for the provision of these services. Payers think that more clinical services should be offered in the community pharmacy. Trust in pharmacist-provided information services on general health and medications, and pharmacist competency were strongly positive. Conclusions and Relevance: A quantitative assessment of payer attitudes for pharmacist-provided, community-delivered advanced clinical practice was positive. Payers were positive about pharmacist contributions to the provision of heath and medication information. Continued development and deployment of advanced clinical services at the community pharmacy appears to be a financially viable model.
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Affiliation(s)
| | - Casey R. Tak
- University of North Carolina at Chapel Hill, NC, USA
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10
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Aznar-Lou I, Iglesias-González M, Rubio-Valera M, Peñarrubia-Maria MT, Mendive JM, Murrugarra-Centurión AG, Gil-Girbau M, González-Suñer L, Peuters C, Serrano-Blanco A. Diagnostic accuracy and treatment approach to depression in primary care: predictive factors. Fam Pract 2019; 36:3-11. [PMID: 30423158 DOI: 10.1093/fampra/cmy098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The study assessed the predictive factors of diagnostic accuracy and treatment approach (antidepressants versus active monitoring) for depression in primary care. METHODS This is a cross-sectional study that uses information from a naturalistic prospective controlled trial performed in Barcelona (Spain) enrolling newly diagnosed patients with mild to moderate depression by GPs. Treatment approach was based on clinical judgement. Diagnosis was later assessed according to DSM-IV criteria using Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) interview by an external researcher. Patients (sociodemographic, psychiatric diagnosis, severity of depression and anxiety, health-related quality of life, disability, beliefs about medication and illness and comorbidities) and GP factors associated with diagnostic accuracy and treatment approach were assessed using multilevel logistic regression. Variables with missing data were imputed through multiple imputations. RESULTS Two hundred sixty-three patients were recruited by 53 GPs. Mean age was 51 years (SD = 15). Thirty percent met DSM-IV criteria for major depression. Mean depression symptomatology was moderate-severe. Using multivariate analyses, patients' beliefs about medicines were the only variable associated with the antidepressant approach. Specialization in general medicine and being a resident tutor were associated with a more accurate diagnosis. CONCLUSIONS Clinical depression diagnosis by GPs was not always associated with a formal diagnosis through a SCID-I. GPs' training background was central to an adequate depression diagnosis. Patients' beliefs in medication were the only factor associated with treatment approach. More resources should be allocated to improving the diagnosis of depression.
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Affiliation(s)
- Ignacio Aznar-Lou
- Teaching, Research and Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Fundació Idiap Jordi Gol i Gurina, Barcelona, Spain
| | - Maria Iglesias-González
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain.,School of Medicine, University of Barcelona, Barcelona, Spain
| | - Maria Rubio-Valera
- Teaching, Research and Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Fundació Idiap Jordi Gol i Gurina, Barcelona, Spain.,Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - M Teresa Peñarrubia-Maria
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Fundació Idiap Jordi Gol i Gurina, Barcelona, Spain.,SAP Delta Llobregat, DAP Costa Ponent, Institut Català de la Salut, Catalonia, Spain
| | - Juan M Mendive
- Fundació Idiap Jordi Gol i Gurina, Barcelona, Spain.,Primary Care Prevention and Health Promotion Research Network (redIAPP), Barcelona, Spain.,La Mina Primary Care Centre, Institut Català de la Salut, Sant Adrià de Besós, Spain
| | - Ana G Murrugarra-Centurión
- Teaching, Research and Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Primary Care Prevention and Health Promotion Research Network (redIAPP), Barcelona, Spain
| | - Montserrat Gil-Girbau
- Teaching, Research and Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Fundació Idiap Jordi Gol i Gurina, Barcelona, Spain.,Primary Care Prevention and Health Promotion Research Network (redIAPP), Barcelona, Spain
| | | | - Carmen Peuters
- Department of Movement and Sports Sciences, Ghent University, Belgium
| | - Antoni Serrano-Blanco
- Teaching, Research and Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Fundació Idiap Jordi Gol i Gurina, Barcelona, Spain.,Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain.,School of Medicine, University of Barcelona, Barcelona, Spain
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11
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Role and impact of pharmacists in Spain: a scoping review. Int J Clin Pharm 2018; 40:1430-1442. [PMID: 30367376 DOI: 10.1007/s11096-018-0740-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 10/13/2018] [Indexed: 10/28/2022]
Abstract
Background The role of the pharmacist has evolved greatly over the last decades, expanding to patient-oriented activities, administrative tasks and public health functions. However, considerable differences emerge across regions. Aim of the review To gather evidence in order to describe and highlight the different characteristics of the pharmacists' role and the impact of their activities in Spain. Method A review of the existing literature was conducted. The literature search was undertaken in PubMed between 01/01/2006 and 15/08/2017. Results were screened and reviewed to extract previously established criteria such as author(s), publication year, language, study design, setting, pharmaceutical activity, patient care programs, targeted diseases and intervention description using DEPICT2 tool. Pharmaceutical intervention were classified into eight outcome measures and categorized by types of outcomes reported: descriptive or impact evaluation regarding the effect of the service (positive, neutral or negative). Results The search strategy resulted in 473 articles and 108 articles met the inclusion criteria. The most common design was observational (n = 76, 70%). Most articles were published after 2011 (75%), in English (69%). Studies were conducted in hospitals (60%) and community pharmacies (30%). Of the 24 pharmaceutical activities identified, medication review was the activity most frequently studied (n = 42), followed by patient education (n = 29), risk and prevention (n = 27) and medication reconciliation (n = 19). Only 39 articles (36%) had outcome measures with impact evaluation. Of the 223 impact outcome measures, 48% (107/223) had a positive effect. Conclusion This review shows the substantial scientific production focusing on pharmacy practice in Spain over the last years. The evidence reviewed reflects the pharmacist role at various professional settings, providing a wide variety of activities on diverse targeted diseases and patient care programs, in line with the increasing specialization of clinical pharmacists over the last years.
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12
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Mateti UV, Nagappa AN, Attur RP, Nagaraju SP, Rangaswamy D. Cost-effectiveness of pharmaceutical care on patients undergoing maintenance hemodialysis - a multicenter randomized controlled study. Postgrad Med 2018; 130:621-626. [PMID: 30047816 DOI: 10.1080/00325481.2018.1504595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The aim of the study is to assess the cost-effectiveness of pharmaceutical care versus usual care on the treatment costs in patients undergoing maintenance hemodialysis (HD) in the outpatient HD centers of academic, government, and corporate hospitals. METHODS An open-labeled randomized controlled study was registered under clinical trial registry of India (Ref. no. CTRI/2014/004900). The study was conducted for a period of 12-month follow-up in patients undergoing maintenance HD. The patients were randomized into Usual Care (UC) group and Pharmaceutical Care (PC) group by the block design method. The UC group received the usual care provided by the hospital staff like physicians, nurses, and technicians whereas, the PC group received the usual care along with the pharmaceutical care delivered by a qualified registered pharmacist. The patient perspective 'out-of-pocket expenditures' was considered for calculating the annual cost incurred for the treatment of HD patients. RESULTS Out of 153 patients, academic hospital (n = 83), government hospital (n = 18), and corporate hospital (n = 52). The incremental cost-effectiveness ratio for academic, government, and corporate hospitals HD patients of PC group compared with UC group were 86,230 Indian Rupee (INR)/Quality-adjusted life year (QALY), 231,016.66 INR/QALY, and 87,430 INR/QALY, respectively. Our study results revealed that PC group was costlier and more effective compared to the UC group. CONCLUSIONS It depends upon the policymakers and regulators to take the decision, if they believe that the extra cost is worth the extra QALY.
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Affiliation(s)
- Uday Venkat Mateti
- a Department of Pharmacy Management , Manipal College of Pharmaceutical Sciences , Mahe , Manipal , India.,b Department of Pharmacy Practice , NGSM Institute of Pharmaceutical Sciences, Nitte (Deemed to be University) , Deralakatte , Mangaluru , India
| | - Anantha Naik Nagappa
- a Department of Pharmacy Management , Manipal College of Pharmaceutical Sciences , Mahe , Manipal , India
| | - Ravindra Prabhu Attur
- c Department of Nephrology , Kasturba Medical College, Kasturba Hospital , MAHE , Manipal , India
| | - Shankar Prasad Nagaraju
- c Department of Nephrology , Kasturba Medical College, Kasturba Hospital , MAHE , Manipal , India
| | - Dharshan Rangaswamy
- c Department of Nephrology , Kasturba Medical College, Kasturba Hospital , MAHE , Manipal , India
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13
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Milosavljevic A, Aspden T, Harrison J. Community pharmacist-led interventions and their impact on patients' medication adherence and other health outcomes: a systematic review. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2018; 26:387-397. [PMID: 29927005 DOI: 10.1111/ijpp.12462] [Citation(s) in RCA: 138] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 04/23/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Medication adherence can be defined as the extent to which one's medication-taking behaviour follows that mutually agreed upon by the prescribing physician. Optimal medication adherence is often deemed crucial for the success of a patient's treatment, as suboptimal adherence may lead to treatment failure and unnecessary medical expenditure. Increasing evidence has highlighted the positive contribution community pharmacist-led interventions can have on improving patients' adherence and health outcomes. OBJECTIVES To provide an overview of the published literature on community pharmacist-led interventions and their effectiveness in improving patients' adherence and health outcomes. METHODS A search strategy was developed, aiming to retrieve published reports of community pharmacy interventions worldwide. Medline, EMBASE, International Pharmaceutical Abstracts, Google Scholar and ProQuest Dissertations and Theses databases were searched. Articles meeting the inclusion criteria were collated, relevant data extracted, and a risk of bias assessment undertaken. KEY FINDINGS Twenty-two studies were included in the analysis, and their outcomes were reported in 26 peer-reviewed journal articles. Community pharmacist-led interventions have been shown to improve patients' adherence and contribute to better blood pressure control, cholesterol management, chronic obstructive pulmonary disease and asthma control. Studies in this review, however, did not report statistically significant effects of interventions on diabetes or depression control. CONCLUSION Community pharmacist-led interventions have been shown to contribute to improved adherence and better disease control. Future research should attempt to better understand which particular intervention components make the greatest contribution towards improving adherence and health outcomes, for patients with different medical conditions.
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Affiliation(s)
| | - Trudi Aspden
- School of Pharmacy, The University of Auckland, Auckland, New Zealand
| | - Jeff Harrison
- School of Pharmacy, The University of Auckland, Auckland, New Zealand
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14
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Ruiz-Rodríguez P, Cano-Vindel A, Muñoz-Navarro R, Wood CM, Medrano LA, Moretti LS. Cost-Effectiveness and Cost-Utility Analysis of the Treatment of Emotional Disorders in Primary Care: PsicAP Clinical Trial. Description of the Sub-study Design. Front Psychol 2018; 9:281. [PMID: 29559944 PMCID: PMC5845711 DOI: 10.3389/fpsyg.2018.00281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 02/19/2018] [Indexed: 01/06/2023] Open
Abstract
Introduction: In the primary care (PC) setting in Spain, the prevalence of emotional disorders (EDs) such as anxiety, depression and somatoform disorder is high. In PC patients, these disorders are not always managed in accordance with the recommendations provided by clinical practice guidelines, resulting in major direct and indirect economic costs and suboptimal treatment outcomes. The aim is to analyze and compare the cost-effectiveness and cost-utility of group-based psychological therapy versus treatment as usual (TAU). Methods: Multicenter, randomized controlled trial involving 300 patients recruited from PC centers in Madrid, Spain, with symptoms or possible diagnosis of anxiety, mood (mild or moderate), or somatoform disorders. Patients will be randomized to one of two groups: an experimental group, which will receive group-based transdiagnostic cognitive-behavioral therapy (TD-CBT); and a control group, which will receive TAU (mainly pharmacological interventions) prescribed by their general practitioner (GP). Clinical assessment will be performed with the Patient Health Questionnaire (PHQ). Direct and indirect costs will be calculated and relevant socio-demographic variables will be registered. The Spanish version of the EuroQol 5D-5L will be administered. Patients will be assessed at baseline, immediately after treatment finalization, and at 6 and 12 months post-treatment. Discussion: To our knowledge, this is the first study to compare TD-CBT to TAU in the PC setting in Spain. This is the first comparative economic evaluation of these two treatment approaches in PC. The strength of the study is that it is a multicenter, randomized, controlled trial of psychotherapy and TAU for EDs in PC. Trial registration: Protocol code: ISCRCTN58437086; 20/05/2013. EUDRACT: 2013-001955-11. Protocol Version: 6, 11/01/2014.
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Affiliation(s)
| | - Antonio Cano-Vindel
- Department of Basic Psychology II (Cognitive Processes), Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
| | - Roger Muñoz-Navarro
- Department of Basic Psychology, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Cristina M Wood
- Department of Basic Psychology II (Cognitive Processes), Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
| | - Leonardo A Medrano
- Department of Psychological Assessment, Universidad Siglo 21, Córdoba, Argentina
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15
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Campins L, Serra-Prat M, Palomera E, Bolibar I, Martínez MÀ, Gallo P. Reduction of pharmaceutical expenditure by a drug appropriateness intervention in polymedicated elderly subjects in Catalonia (Spain). GACETA SANITARIA 2017; 33:106-111. [PMID: 29162290 DOI: 10.1016/j.gaceta.2017.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/05/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To assess the monetary savings resulting from a pharmacist intervention on the appropriateness of prescribed drugs in community-dwelling polymedicated (≥8 drugs) elderly people (≥70 years). METHOD An evaluation of pharmaceutical expenditure reduction was performed within a randomised, multicentre clinical trial. The study intervention consisted of a pharmacist evaluation of all drugs prescribed to each patient using the "Good Palliative-Geriatric Practice" algorithm and the "Screening Tool of Older Persons Prescriptions/Screening Tool to Alert doctors to Right Treatment" criteria (STOPP/START). The control group followed the routine standard of care. A time horizon of one year was considered and cost elements included human resources and drug expenditure. RESULTS 490 patients (245 in each group) were analysed. Both groups experienced a decrease in drug expenditure 12 months after the study started, but this decrease was significantly higher in the intervention group than in the control group (-14.3% vs.-7.7%; p=0.041). Total annual drug expenditure decreased 233.75 €/patient (95% confidence interval [95%CI]: 169.83-297.67) in the intervention group and 169.40 €/patient (95%CI: 103.37-235.43) in the control group over a one-year period, indicating that 64.30 € would be the drug expenditure savings per patient a year attributable to the study intervention. The estimated return per Euro invested in the programme would be 2.38 € per patient a year on average. CONCLUSIONS The study intervention is a cost-effective alternative to standard care that could generate a positive return of investment.
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Affiliation(s)
- Lluís Campins
- Pharmacy Department, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró (Barcelona), Spain
| | - Mateu Serra-Prat
- Research Unit, Consorci Sanitari del Maresme, Mataró (Barcelona), Spain; CIBER de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain.
| | - Elisabet Palomera
- Research Unit, Consorci Sanitari del Maresme, Mataró (Barcelona), Spain
| | - Ignasi Bolibar
- Public Health and Clinical Epidemiology Department, Institut de Recerca Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Miquel Àngel Martínez
- Argentona Primary Care Centre, Consorci Sanitari del Maresme, Argentona (Barcelona), Spain
| | - Pedro Gallo
- Department of Sociology, Faculty of Economics and Business, University of Barcelona, Barcelona, Spain
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Perraudin C, Bugnon O, Pelletier-Fleury N. Expanding professional pharmacy services in European community setting: Is it cost-effective? A systematic review for health policy considerations. Health Policy 2016; 120:1350-1362. [DOI: 10.1016/j.healthpol.2016.09.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 08/02/2016] [Accepted: 09/18/2016] [Indexed: 10/20/2022]
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17
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Malet-Larrea A, García-Cárdenas V, Sáez-Benito L, Benrimoj SI, Calvo B, Goyenechea E. Cost-effectiveness of professional pharmacy services in community pharmacy: a systematic review. Expert Rev Pharmacoecon Outcomes Res 2016; 16:747-758. [DOI: 10.1080/14737167.2016.1259071] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- A Malet-Larrea
- Pharmaceutical Technology Department, Faculty of Pharmacy, University of the Basque Country, Vitoria-Gasteiz, Spain
| | - V García-Cárdenas
- Graduate School of Health, University of Technology Sydney, NSW, Sydney, Australia
| | - L Sáez-Benito
- Faculty of Health Sciences, Pharmacy Department, San Jorge University, Villanueva de Gállego, Zaragoza, Spain
| | - SI Benrimoj
- Graduate School of Health, University of Technology Sydney, NSW, Sydney, Australia
| | - B Calvo
- Pharmaceutical Technology Department, Faculty of Pharmacy, University of the Basque Country, Vitoria-Gasteiz, Spain
| | - E Goyenechea
- Technical Management Department, Official Pharmacist Association of Guipuzcoa, Donostia-San Sebastian, Spain
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18
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Gammie T, Vogler S, Babar ZUD. Economic Evaluation of Hospital and Community Pharmacy Services. Ann Pharmacother 2016; 51:54-65. [DOI: 10.1177/1060028016667741] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To review the international body of literature from 2010 to 2015 concerning methods of economic evaluations used in hospital- and community-based studies of pharmacy services in publicly funded health systems worldwide, their clinical outcomes, and economic effectiveness. Data Sources: The literature search was undertaken between May 2, 2015, and September 4, 2015. Keywords included “health economics” and “evaluation” “assessment” or “appraisal,” “methods,” “hospital” or “community” or “residential care,” “pharmacy” or “pharmacy services” and “cost minimisation analysis” or “cost utility analysis” or “cost effectiveness analysis” or “cost benefit analysis.” The databases searched included MEDLINE, PubMed, Google Scholar, Science Direct, Springer Links, and Scopus, and journals searched included PLoS One, PLoS Medicine, Nature, Health Policy, Pharmacoeconomics, The European Journal of Health Economics, Expert Review of Pharmacoeconomics and Outcomes Research, and Journal of Health Economics. Study Selection and Data Extraction: Studies were selected on the basis of study inclusion criteria. These criteria included full-text original research articles undertaking an economic evaluation of hospital- or community-based pharmacy services in peer-reviewed scientific journals and in English, in countries with a publicly funded health system published between 2010 and 2015. Data Synthesis: 14 articles were included in this review. Cost-utility analysis (CUA) was the most utilized measure. Cost-minimization analysis (CMA) was not used by any studies. The limited use of cost-benefit analyses (CBAs) is likely a result of technical challenges in quantifying the cost of clinical benefits, risks, and outcomes. Hospital pharmacy services provided clinical benefits including improvements in patient health outcomes and reductions in adverse medication use, and all studies were considered cost-effective due to meeting a cost-utility (per quality-adjusted life year) threshold or were cost saving. Community pharmacy services were considered cost-effective in 8 of 10 studies. Conclusions: Economic evaluations of hospital and community pharmacy services are becoming increasingly commonplace to enable an understanding of which health care services provide value for money and to inform policy makers as to which services will be cost-effective in light of limited health care resources.
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Affiliation(s)
- Todd Gammie
- University of Auckland, Auckland, New Zealand
| | - Sabine Vogler
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Vienna, Austria
| | - Zaheer-Ud-Din Babar
- University of Auckland, Auckland, New Zealand
- Lahore Pharmacy College (A project of Lahore Medical and Dental College), Tulspura Canal Bank, Lahore, Pakistan
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Simon-Tuval T, Neumann PJ, Greenberg D. Cost-effectiveness of adherence-enhancing interventions: a systematic review. Expert Rev Pharmacoecon Outcomes Res 2016; 16:67-84. [DOI: 10.1586/14737167.2016.1138858] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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20
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Rubio-Valera M, Bosmans J, Fernández A, Peñarrubia-María M, March M, Travé P, Bellón JA, Serrano-Blanco A. Correction: Cost-Effectiveness of a Community Pharmacist Intervention in Patients with Depression: A Randomized Controlled Trial (PRODEFAR Study). PLoS One 2016; 11:e0147459. [PMID: 26765519 PMCID: PMC4713208 DOI: 10.1371/journal.pone.0147459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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21
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Portela MC, Pronovost PJ, Woodcock T, Carter P, Dixon-Woods M. How to study improvement interventions: a brief overview of possible study types. Postgrad Med J 2015; 91:343-54. [PMID: 26045562 PMCID: PMC4484358 DOI: 10.1136/postgradmedj-2014-003620rep] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Improvement (defined broadly as purposive efforts to secure positive change) has become an increasingly important activity and field of inquiry within healthcare. This article offers an overview of possible methods for the study of improvement interventions. The choice of available designs is wide, but debates continue about how far improvement efforts can be simultaneously practical (aimed at producing change) and scientific (aimed at producing new knowledge), and whether the distinction between the practical and the scientific is a real and useful one. Quality improvement projects tend to be applied and, in some senses, self-evaluating. They are not necessarily directed at generating new knowledge, but reports of such projects if well conducted and cautious in their inferences may be of considerable value. They can be distinguished heuristically from research studies, which are motivated by and set out explicitly to test a hypothesis, or otherwise generate new knowledge, and from formal evaluations of improvement projects. We discuss variants of trial designs, quasi-experimental designs, systematic reviews, programme evaluations, process evaluations, qualitative studies, and economic evaluations. We note that designs that are better suited to the evaluation of clearly defined and static interventions may be adopted without giving sufficient attention to the challenges associated with the dynamic nature of improvement interventions and their interactions with contextual factors. Reconciling pragmatism and research rigour is highly desirable in the study of improvement. Trade-offs need to be made wisely, taking into account the objectives involved and inferences to be made.
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Affiliation(s)
- Margareth Crisóstomo Portela
- Social Science Applied to Healthcare Research (SAPPHIRE) Group, Department of Health Sciences, School of Medicine, University of Leicester, Leicester, UK Department of Health Administration and Planning, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Peter J Pronovost
- Departments of Anesthesiology, Critical Care Medicine, and Surgery, Armstrong Institute for Patient Safety and Quality, School of Medicine, and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Thomas Woodcock
- NIHR CLAHRC for Northwest London, Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - Pam Carter
- Social Science Applied to Healthcare Research (SAPPHIRE) Group, Department of Health Sciences, School of Medicine, University of Leicester, Leicester, UK
| | - Mary Dixon-Woods
- Social Science Applied to Healthcare Research (SAPPHIRE) Group, Department of Health Sciences, School of Medicine, University of Leicester, Leicester, UK
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Rubio-Valera M, Beneitez I, Peñarrubia-María MT, Luciano JV, Mendive JM, McCrone P, Knapp M, Sabés-Figuera R, Kocyan K, García-Campayo J, Serrano-Blanco A. Cost-effectiveness of active monitoring versus antidepressants for major depression in primary health care: a 12-month non-randomized controlled trial (INFAP study). BMC Psychiatry 2015; 15:63. [PMID: 25885818 PMCID: PMC4394418 DOI: 10.1186/s12888-015-0448-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 03/18/2015] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Clinical practice guidelines for the treatment of major depressive disorder (MDD) recommend antidepressants for patients with moderate-severe depression and active monitoring for patients with mild-moderate symptoms. The feasibility and efficiency of active monitoring has not been proven conclusively. The aim of this study is to evaluate the cost-effectiveness of active monitoring in comparison to antidepressants for primary care patients with mild-moderate MDD. METHODS/DESIGN This is a 12-month follow-up multicenter observational prospective controlled trial. Patients are enrolled in 12 primary care centers in Barcelona (Spain). Eligible patients are adults (≥18 years-old) with a new episode of MDD that sign a written consent to participate. This is a naturalistic study in which general practitioners (GPs) use their professional judgment to allocate patients into active monitoring or antidepressants groups. GPs treat the patients following their clinical criteria. At baseline, GPs complete a questionnaire (sociodemographic/job characteristics, training, attitude towards depression, interest on mental health and participation in communication groups). Patients' measurements take place at baseline and after six and 12 months. Main outcome measures include severity of depression (PHQ-9), health-related quality of life (EuroQol-5D) and use of healthcare and social care services (Client Service Receipt Inventory). Secondary outcomes include diagnosis of MDD according to DSM-IV diagnostic criteria (SCID-I), disability (WHO-DAS), anxiety (BAI), comorbidities, medication side-effects and beliefs about medicines (BMQ). The analysis will be done according to the intention to treat analysis. Missing data will be imputed using multiple imputation by chained equations. To minimize the bias resulting from the lack of randomization, a propensity score will be used. Incremental effects and costs between groups will be modelled in each of the imputed databases using multivariate generalized linear models and then combined as per Rubin's rules. Propensity scores will be used to adjust the models. Incremental cost-effectiveness ratios will be calculated by dividing the difference in costs between groups by the difference in effects. To deal with the uncertainty, resampling techniques with bootstrapping will be used and cost-effectiveness planes and cost-effectiveness acceptability curves will be constructed. A series of sensitivity analyses will be performed. DISCUSSION Given the high burden and costs generated by depressive disorder, it is important that general practitioners treat major depression efficiently. Recent evidence has suggested that antidepressants have low benefits for patients with mild to moderate major depression. For such cases of depression, active monitoring exists as a treatment option, but it is not without difficulties for implementation and its effectiveness and efficiency have not been demonstrated conclusively. The results of the study will provide information on which is the most efficient approach to treat patients with mild to moderate major depression in primary care. TRIAL REGISTRATION ClinicalTrials.gov: NCT02245373.
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Affiliation(s)
- Maria Rubio-Valera
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Spain. .,Primary Care Prevention and Health Promotion Research Network (RedIAPP), Barcelona, Spain. .,School of Pharmacy, Universitat de Barcelona, Barcelona, Spain.
| | - Imma Beneitez
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Spain. .,Open University of Catalonia (UOC), Barcelona, Spain.
| | - María Teresa Peñarrubia-María
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Barcelona, Spain. .,Primary Care Health Centre Bartomeu Fabrés Anglada, Servei d'Atenció Primària Delta Llobregat, Àmbit Costa de Ponent, Institut Català de la Salut, Gavà, Spain.
| | - Juan V Luciano
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Spain. .,Primary Care Prevention and Health Promotion Research Network (RedIAPP), Barcelona, Spain. .,Open University of Catalonia (UOC), Barcelona, Spain.
| | - Juan M Mendive
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Barcelona, Spain. .,La Mina Primary Care Centre, Institut Català de la Salut, Sant Adrià de Besós, Barcelona, Spain.
| | - Paul McCrone
- Institute of Psychiatry, King's College London, De Crespigny Park, London, UK.
| | - Martin Knapp
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London, UK.
| | - Ramon Sabés-Figuera
- Institute for Prospective Technological Studies/Joint Research Centre, European Commission, Sevilla, Spain.
| | | | - Javier García-Campayo
- Miguel Servet Hospital, University of Zaragoza, Instituto Aragones de Ciencias de la Salud, Zaragoza, Spain.
| | - Antoni Serrano-Blanco
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Barcelona, Spain. .,Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain.
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Portela MC, Pronovost PJ, Woodcock T, Carter P, Dixon-Woods M. How to study improvement interventions: a brief overview of possible study types. BMJ Qual Saf 2015; 24:325-36. [PMID: 25810415 PMCID: PMC4413733 DOI: 10.1136/bmjqs-2014-003620] [Citation(s) in RCA: 176] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 02/16/2015] [Indexed: 12/16/2022]
Abstract
Improvement (defined broadly as purposive efforts to secure positive change) has become an increasingly important activity and field of inquiry within healthcare. This article offers an overview of possible methods for the study of improvement interventions. The choice of available designs is wide, but debates continue about how far improvement efforts can be simultaneously practical (aimed at producing change) and scientific (aimed at producing new knowledge), and whether the distinction between the practical and the scientific is a real and useful one. Quality improvement projects tend to be applied and, in some senses, self-evaluating. They are not necessarily directed at generating new knowledge, but reports of such projects if well conducted and cautious in their inferences may be of considerable value. They can be distinguished heuristically from research studies, which are motivated by and set out explicitly to test a hypothesis, or otherwise generate new knowledge, and from formal evaluations of improvement projects. We discuss variants of trial designs, quasi-experimental designs, systematic reviews, programme evaluations, process evaluations, qualitative studies, and economic evaluations. We note that designs that are better suited to the evaluation of clearly defined and static interventions may be adopted without giving sufficient attention to the challenges associated with the dynamic nature of improvement interventions and their interactions with contextual factors. Reconciling pragmatism and research rigour is highly desirable in the study of improvement. Trade-offs need to be made wisely, taking into account the objectives involved and inferences to be made.
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Affiliation(s)
- Margareth Crisóstomo Portela
- Social Science Applied to Healthcare Research (SAPPHIRE) Group, Department of Health Sciences, School of Medicine, University of Leicester, Leicester, UK Department of Health Administration and Planning, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Peter J Pronovost
- Departments of Anesthesiology, Critical Care Medicine, and Surgery, Armstrong Institute for Patient Safety and Quality, School of Medicine, and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Thomas Woodcock
- NIHR CLAHRC for Northwest London, Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - Pam Carter
- Social Science Applied to Healthcare Research (SAPPHIRE) Group, Department of Health Sciences, School of Medicine, University of Leicester, Leicester, UK
| | - Mary Dixon-Woods
- Social Science Applied to Healthcare Research (SAPPHIRE) Group, Department of Health Sciences, School of Medicine, University of Leicester, Leicester, UK
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