The impact of comprehensive medication management services on clinical outcomes in patients with cardiovascular diseases at primary care level

doctoral thesis

• Title (english): Utjecaj usluge upravljanja farmakoterapijom na kliničke ishode u pacijenata s kardiovaskularnim bolestima na razini primarne zdravstvene zaštite
• Author: Andrea Brajković
• Mentor: Iva Mucalo (mentor)
• Mentor: Djenane Ramalho de Oliveira https://orcid.org/0000-0002-5548-8184 (komentor)
• Committee member: Maja Ortner Hadžiabdić (predsjednik povjerenstva)
• Committee member: Petra Turčić (član povjerenstva)
• Committee member: Srećko Marušić (član povjerenstva)
• Granter: University of Zagreb; Faculty of Pharmacy and Biochemistry; (Centre for applied pharmacy); Zagreb
• Defense date and country: 2023-04-21, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Pharmacy; Pharmacy
• Universal decimal classification (UDC): 615 - Pharmacology. Therapeutics. Toxicology

Abstract

Patients with established cardiovascular diseases (CVDs) often use multiple medications that increase the risk of irrational drug use, subsequently leading to unfavourable clinical and health outcomes. New pharmacist's intervention named Comprehensive Medication Management (CMM) services provided at the primary care level could address the abovementioned problem by optimizing patients' therapy and improving their outcomes. Hence, the main aim of this dissertation was to evaluate the impact of CMM services on healthcare utilisation, cardiovascular risk factors and health-related quality of life (HRQoL) among older patients with established CVDs. Moreover, the study aimed to describe the newly implemented practice management system of CMM services at the primary care level and to predict CMM’s budget impact on Croatian health insurance fund. Results showed that the intervention group patients receiving CMM services had significantly lower systolic (p = 0.038) and diastolic blood pressure (p = 0.001), total cholesterol (p = 0.014), low-density lipoprotein cholesterol (p = 0.005), and glycosylated haemoglobin (p = 0.045) in comparison to the control group. Moreover, patients in the control group had 3.35 (95% CI 1.16–10.00) and 2.34 (95% CI 1.52–3.57) times higher number of hospital admissions and unplanned GPs visits compared to the intervention group, respectively. The HRQoL was measured in the intervention group by using the EQ-5D-5L questionnaire. A significant improvement in dimensions “self-care” (p = 0.011) and “usual activities” (p = 0.003) was found. The implementation process included two stages: a pre-implementation stage that set the groundwork for the early implementation stage. The budget impact analysis employed in this research led to a CMM's net budget impact of EUR 92,869 and EUR 0.67 incremental cost per patient within a 3-year horizon, rendering CMM an affordable intervention for the Croatian healthcare system. The results of this dissertation add to the evidence base supporting the CMM’s full implementation in the Croatian health care system by demonstrating that CMM interventions can significantly contribute to better clinical outcomes and lower healthcare utilisation, may improve patients’ HRQoL, thus serving as a viable solution for safety management in older patients with hypertension and established CVDs at the primary care level.

Abstract (english)

Pacijenti s postojećim kardiovaskularnim bolestima (KVB) često koriste veći broj lijekova što vodi k neracionalnoj uporabi lijekova te posljedično doprinosi nepovoljnim kliničkim i zdravstvenim ishodima. Kao posljedica spomenutog pojavila se potreba za uvođenjem nove ljekarničke intervencije usmjerene optimizaciji terapije pacijenata i poboljšanju ishoda - usluge upravljanja farmakoterapijom (UFT). Glavni cilj ovog doktorskog rada bio je utvrditi utjecaj usluge UFT na utilizaciju zdravstvene skrbi, kardiovaskularne rizične čimbenike, i kvalitetu života povezanu sa zdravljem u pacijenata starije životne dobi s KVB. Dodatno, cilj ovog istraživanja bio je opisati cjelokupni proces rane implementacije usluge UFT u Dom zdravlja Zagreb – Centar te procijeniti utjecaj usluge UFT na hrvatski zdravstveni proračun. Ovo je istraživanje pokazalo da su pacijenti u intervencijskoj skupini koji su primali uslugu UFT imali statistički značajno niži sistolički (p = 0,038) i dijastolički krvni tlak (p = 0,001), LDL-kolesterol (p = 0,005), ukupni kolesterol (p = 0,014) i glikirani hemoglobin (p = 0,045) u odnosu na pacijente iz kontrolne skupine. Vjerojatnost hospitalizacije i nenadanih posjeta LOM-u bili su 3,35 (95% CI 1,16-10,00) i 2,34 (95% CI 1,52-3,57) puta veći u kontrolnoj skupini u odnosu na intervencijsku skupinu. Kvaliteta života vezane uz zdravlje pacijenata mjerena je pomoću EQ-5D-5L upitnika u intervencijskoj grupi. Do statistički značajnog poboljšanja došlo je u dvije dimenzije: „skrb o sebi“ (p = 0,011) i „uobičajene aktivnosti“ (p = 0,003). Proces inicijalne implementacije uključivao je dvije faze: pred-implementacijsku fazu (pripremna faza) koja je postavila temelje za fazu rane implementacije. Rezultati studije utjecaja usluge UFT na proračun pokazali su da bi uvođenje usluge UFT u zdravstveni sustav opteretilo proračun u iznosu od 92.869 EUR (po liječenom pacijentu 0,67 EUR) tijekom tri godine što se smatra cjenovno pristupačnom intervencijom. Rezultati ovog doktorskog rada predstavljaju značajan doprinos postojećim dokazima koji podržavaju potpunu implementaciju usluge UFT u hrvatski zdravstveni sustav pokazujući da ova ljekarnička intervencija značajno doprinosi poboljšanju kliničkih ishoda, smanjenju utilizacije zdravstvene skrbi te da može poboljšati kvalitetu života vezanu uz zdravlje, predstavljajući tako održivo rješenje za osiguravanje sigurne terapije pacijenata starije životne dobi s hipertenzijom i KVB na razini primarne zdravstvene zaštite.

• Keywords: comprehensive medication management services; pharmaceutical care; nonrandomised; primary health care; cardiovascular diseases; older patients; clinical outcomes
• Keywords (english): usluga upravljanja farmakoterapijom; ljekarnička skrb; nerandomizacija; primarna zdravstvena zaštita; kardiovaskularne bolesti; pacijenti starije životne dobi; klinički ishodi
• Language: english
• URN:NBN: urn:nbn:hr:163:061401
• Promotion: 2023
• Study programme: Title: Pharmacy and biochemistry; Study programme type: university; Study level: postgraduate; Academic / professional title: doktor znanosti (doktor znanosti)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-05-08 13:26:13