Effectiveness of pharmaceutical care introduced in coordination with PHC – study design.

Abstract

Pharmacist services have the potential to lower medical costs and improve patients' clinical outcomes. However, when compared to usual care, depending on the service kind, pharmacist’s services have a varying impact on patient outcomes. Some services appear to have little impact, while others have the potential to improve outcomes on a scale that is clinically relevant. Pharmacists in Poland have received rights to provide additional services to patients in 2021, but new services have not yet been implemented. Although there has been research on impact on patient outcomes of various pharmaceutical interventions, those interventions have been observed in a silos, with little to no care coordination with primary health care.
 Objective of the planned research project is to analyse cost-effectiveness of non-dispensing pharmaceutical services realized as part of coordinated care with primary care providers.
 The research project will be carried out at Medical and Diagnostic Center (MDC) in Siedlce, Poland, where a number of pharmaceutical services have been already introduced. Those have been developed in collaboration between pharmacists, physicians and nurses working in MDC and include:
 
 medication reviews – assessment of patient’s pharmacotherapy and patient’s general health, usually after primary care doctor’s referral,
 medication consultation – educating patient on the use of medicines for a given illness,
 pharmaceutical assistance – preparing medicine sets for patient,
 health prophylaxis and diagnosis – patient education on health prophylaxis, combating vaccine-hesitancy in patients, assistance in combating addictions,
 intervention/urgent visit – health assessment in connection with a minor ailment,
 patient digitalization – assessment of main technical issues related to care coordination, including setting up patient’s account in Polish electronic health record system and MDC account,
 internal pharmaceutical consultation – consultation on patient’s pharmacotherapy between pharmacists and primary care doctor, specialist or nurse via phone, online system or on-site appointment..
 
 To deliver those services, pharmacists will have access to information collected at time of the patient encounter as well as additional set of clinical data from internal MDC IT system. IT system would also allow for communication between different healthcare professionals, allowing for recommendations and referrals.
 A method used in the project will be a controlled intervention study with pre-post comparison between patients receiving pharmaceutical care services and care as usual. Study would look to include at least 200 patients. Outcome measurements will be pharmacotherapy-related problems (drug interactions, drug contraindications, incorrect and not recommended dosing, non-adherence), 12-month clinical outcomes of patients (percentage outside blood pressure range, percentage outside glycated haemoglobin range, SF-36 physical functioning, drug burden index, medication-related hospital admissions), number of pharmaceutical consultations delivered to physicians, and costs. Study will also collect patient experiences with the interventions and their opinions will be used to improve services in the future.
 The research is looking to bridge the science gap in cost and effectiveness assessment of pharmaceutical care services, improve patients’ health outcomes and help bring organizational and financial improvements to healthcare sector.