Background: The UK Community Pharmacy Future group developed the Pharmacy Care Plan (PCP) service with a focus on patient activation, goal setting and therapy management.
Objective: To estimate the effectiveness and cost-effectiveness of the PCP service from a health services perspective.
Methods: Patients over 50 years of age prescribed one or more medicines including at least one for cardiovascular disease or diabetes were eligible. Medication review and person-centred consultation resulted in agreed health goals and actions towards achieving them. Clinical, process and cost-effectiveness data were collected at baseline and 12-months between February 2015 and June 2016. Mean differences are reported for clinical and process measures. Costs (NHS) and quality-adjusted life year scores were estimated and compared for 12 months pre- and post-baseline.
Results: Seven hundred patients attended the initial consultation and 54% had a complete set of data obtained. There was a significant improvement in patient activation score (mean difference 5.39; 95% CI 3.9-6.9; p < 0.001), systolic (mean difference -2.90 mmHg; 95% CI -4.7 to -1; p = 0.002) and diastolic blood pressure (mean difference -1.81 mmHg; 95% CI -2.8 to -0.8; p < 0.001), adherence (mean difference 0.26; 95% CI 0.1-0.4; p < 0.001) and quality of life (mean difference 0.029; 95% CI 0.015-0.044; p < 0.001). HDL cholesterol reduced significantly and QRisk2 scores increased significantly over the course of the 12 months. The mean incremental cost associated with the intervention was estimated to be £202.91 (95% CI 58.26 to £346.41) and the incremental QALY gain was 0.024 (95% CI 0.014 to 0.034), giving an incremental cost per QALY of £8495.
Conclusions: Enrolment in the PCP service was generally associated with an improvement over 12 months in key clinical and process metrics. Results also suggest that the service would be cost-effective to the health system even when using worst case assumptions.
Keywords: Community pharmacy; Cost-effectiveness; Goal setting; Long-term conditions; Patient activation; United Kingdom.
Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.