Hsiang-Wen Lin1, Chih-Hsueh Lin2, Chin-Kai Chang3, Che-Yi Chou4, I-Wen Yu5, Cheng-Chieh Lin6, Tsai-Chung Li7, Chia-Ing Li8, Yow-Wen Hsieh9. 1. School of Pharmacy and Graduate Institute, College of Pharmacy, China Medical University, Taichung, Taiwan; Department of Pharmacy, China Medical University Hospital, Taichung, Taiwan; Department of Pharmacy Systems, Outcomes & Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA. Electronic address: hsiangwl@gmail.com. 2. Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan. 3. Department of Rehabilitation, China Medical University Hospital, Taichung, Taiwan. 4. Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan. 5. Supra Integration and Incubation Center, Taipei, Taiwan. 6. Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan. 7. Graduate Institute of Biostatistics, China Medical University, Taichung, Taiwan. 8. Department of Medical Research, China Medical University Hospital, Taichung, Taiwan. 9. School of Pharmacy and Graduate Institute, College of Pharmacy, China Medical University, Taichung, Taiwan; Department of Pharmacy, China Medical University Hospital, Taichung, Taiwan.
Abstract
BACKGROUND/ PURPOSE: With an increasing geriatric population, the need for effective management of chronic conditions and medication use in the elderly is growing. Medication use in the elderly presents significant challenges due to changes in pharmacodynamic and pharmacokinetic profiles. We aimed to examine the impact of a collaborative physician-pharmacist medication therapy management (MTM) program for polypharmacy elderly patients. METHODS:Elderly patients with multiple chronic conditions on polypharmacy were enrolled in this prospective, randomized, and controlled study over 16 months of implementation. The intervention group consisted of patients randomized to a collaborative pharmacist-physician MTM program. They were monitored continuously by a clinical pharmacist, while patients in the control group received only usual care with follow-up assessment. Primary outcome was economic differences, measured in total medical expenditure. Secondary outcomes of clinical and humanistic effects were compared between the two groups. RESULTS: The total number of enrolled patients was 87 and 91 in the MTM and usual groups, respectively. The difference-in-difference estimate on medical expenditure during the 16-month implementation period was $3,758,373 New Taiwan Dollars ($127,015 US Dollars) less than the usually care group. Impact was also seen in humanistic outcomes while lipid profiles and mortality trended toward improvement. CONCLUSION: The pharmacist-physician collaborative MTM program for polypharmacy elderly had significant cost savings and improvement in humanistic measures, demonstrating the importance of clinical pharmacists and MTM programs for elderly patients in Taiwan. The results suggest the possibility of clinical benefits, but the study was not substantially powered to find a statistical difference.
RCT Entities:
BACKGROUND/ PURPOSE: With an increasing geriatric population, the need for effective management of chronic conditions and medication use in the elderly is growing. Medication use in the elderly presents significant challenges due to changes in pharmacodynamic and pharmacokinetic profiles. We aimed to examine the impact of a collaborative physician-pharmacist medication therapy management (MTM) program for polypharmacy elderly patients. METHODS: Elderly patients with multiple chronic conditions on polypharmacy were enrolled in this prospective, randomized, and controlled study over 16 months of implementation. The intervention group consisted of patients randomized to a collaborative pharmacist-physician MTM program. They were monitored continuously by a clinical pharmacist, while patients in the control group received only usual care with follow-up assessment. Primary outcome was economic differences, measured in total medical expenditure. Secondary outcomes of clinical and humanistic effects were compared between the two groups. RESULTS: The total number of enrolled patients was 87 and 91 in the MTM and usual groups, respectively. The difference-in-difference estimate on medical expenditure during the 16-month implementation period was $3,758,373 New Taiwan Dollars ($127,015 US Dollars) less than the usually care group. Impact was also seen in humanistic outcomes while lipid profiles and mortality trended toward improvement. CONCLUSION: The pharmacist-physician collaborative MTM program for polypharmacy elderly had significant cost savings and improvement in humanistic measures, demonstrating the importance of clinical pharmacists and MTM programs for elderly patients in Taiwan. The results suggest the possibility of clinical benefits, but the study was not substantially powered to find a statistical difference.
Authors: A Jeong Kim; Hayeon Lee; Eun-Jeong Shin; Eun-Jung Cho; Yoon Sook Cho; Hajeong Lee; Ju-Yeun Lee Journal: Int J Environ Res Public Health Date: 2021-04-20 Impact factor: 3.390
Authors: M Kurczewska-Michalak; P Lewek; B Jankowska-Polańska; A Giardini; N Granata; M Maffoni; E Costa; L Midão; P Kardas Journal: Front Pharmacol Date: 2021-11-26 Impact factor: 5.810
Authors: Jennifer Valeska Elli Brown; Nick Walton; Nicholas Meader; Adam Todd; Lisa Ad Webster; Rachel Steele; Stephanie J Sampson; Rachel Churchill; Dean McMillan; Simon Gilbody; David Ekers Journal: Cochrane Database Syst Rev Date: 2019-12-23