The Asheville Project: Clinical and economic outcomes of a community-based long-term medication therapy management program for hypertension and dyslipidemia

被引:232
作者
Bunting, Barry A. [1 ]
Smith, Benjamin H. [2 ]
Sutherland, Susan E. [3 ]
机构
[1] American Hlth Care, Clin Serv, Rocklin, CA USA
[2] Medicat Assistance Program, Hlth Educ Ctr, Rocklin, CA USA
[3] Miss Hosp, Res Inst, Asheville, NC USA
关键词
Asheville Project; medication therapy management; disease managemeat; hypertension; dyslipidemia; cardiovascular risk; health care costs; health outcomes; pharmacoceconomics;
D O I
10.1331/JAPhA.2008.07140
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
Objective: Assess clinical and economic outcomes of a community-based, long-term medication therapy management (MTM) program for hypertension (HTN)/dyslipidemia. Design: Quasi-experimental, longitudinal, pre-post study. Setting: 12 community and hospital pharmacy clinics in Asheville, N.C., over a 6-year period from 2000 through 2005. Participants: Patients covered by two self-insured health plans; educators at Mission Hospitals; 18 certificate-trained pharmacists. Interventions: Cardiovascular or cerebrovascular (collectively abbreviated as CV) risk reduction education; regular, long-term follow-up by pharmacists (reimbursed by health plans) using scheduled consultations, monitoring, and recommendations to physicians. Main outcome measures: Clinical and economic parameters. Results: Sufficient data were available for 620 patients in the financial cohort and 565 patients in clinical cohort. Several indicators of cardiovascular health improved over the course of the study: mean systolic blood pressure, from 137.3 to 126.3 HIM Hg; mean diastolic blood pressure, from 82.6 to 77.8 mm Hg; percentage of patients at blood pressure goal, from 40.2% to 67.4%; mean low-density lipoprotein (LDL) cholesterol, from 127.2 to 108.3 mg/dL; percentage of patients at LDL cholesterol goal, from 49.9% to 74.6%; mean total cholesterol, from 211.4 to 184.3 mg/dL; and mean serum triglycerides, from 192.8 to 154.4 mg/dL. Mean high-density lipoprotein (HDL) cholesterol decreased from 48 to 46.6 mg/dL. The CV event rate during the historical period, 77 per 1,000 person-years, declined by almost one-half (38 per 1,000 person-years) during the study period. Mean cost per CV event in the study period was $9,931, compared with $14,343 during the historical period. During the studyperiod, CV medication use increased nearly threefold, but CV-related medical costs decreased by 46.5%. CV-related medical costs decreased from 30.6% of total health care costs to 49%. A 53% decrease in risk of a CV event and greater than 50% decrease in risk of a CV-related emergency department (ED)/hospital visit were also observed. Conclusion: Patients with HTN and/or dyslipidemia receiving education and long-term MTM services achieved significant clinical improvements that were sustained for as long as 6 years, a significant increase in the use of CV medications, and a decrease in CV events and related medical costs.
引用
收藏
页码:23 / 31
页数:9
相关论文
共 8 条
[1]  
*AM HEART ASS, 2007, HEART DIS STROK STAT
[2]  
Bluml B M, 2000, J Am Pharm Assoc (Wash), V40, P157
[3]   The Asheville Project: Long-term clinical, humanistic, and economic outcomes of a community-based medication therapy management program for asthma [J].
Bunting, Barry A. ;
Cranor, Carole W. .
JOURNAL OF THE AMERICAN PHARMACISTS ASSOCIATION, 2006, 46 (02) :133-147
[4]  
*BUR LAVB STAT, CONS PRIC IND MED CA
[5]   Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure [J].
Chobanian, AV ;
Bakris, GL ;
Black, HR ;
Cushman, WC ;
Green, LA ;
Izzo, JL ;
Jones, DW ;
Materson, BJ ;
Oparil, S ;
Wright, JT ;
Roccella, EJ .
HYPERTENSION, 2003, 42 (06) :1206-1252
[6]   Executive summary of the Third Report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) [J].
Cleeman, JI ;
Grundy, SM ;
Becker, D ;
Clark, LT ;
Cooper, RS ;
Denke, MA ;
Howard, WJ ;
Hunninghake, DB ;
Illingworth, DR ;
Luepker, RV ;
McBride, P ;
McKenney, JM ;
Pasternak, RC ;
Stone, NJ ;
Van Horn, L ;
Brewer, HB ;
Ernst, ND ;
Gordon, D ;
Levy, D ;
Rifkind, B ;
Rossouw, JE ;
Savage, P ;
Haffner, SM ;
Orloff, DG ;
Proschan, MA ;
Schwartz, JS ;
Sempos, CT ;
Shero, ST ;
Murray, EZ .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2001, 285 (19) :2486-2497
[7]  
Cranor Carole W, 2003, J Am Pharm Assoc (Wash), V43, P173, DOI 10.1331/108658003321480713
[8]   AHA guidelines for primary prevention of cardiovascular disease and stroke: 2002 update - Consensus panel guide to comprehensive risk reduction for adult patients without coronary or other atherosclerotic vascular diseases [J].
Pearson, TA ;
Blair, SN ;
Daniels, SR ;
Eckel, RH ;
Fair, JM ;
Fortmann, SP ;
Franklin, BA ;
Goldstein, LB ;
Greenland, P ;
Grundy, SM ;
Hong, YL ;
Miller, NH ;
Lauer, RM ;
Ockene, IS ;
Sacco, RL ;
Sallis, JF ;
Smith, SC ;
Stone, NJ ;
Taubert, KA .
CIRCULATION, 2002, 106 (03) :388-391