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

Autori
Brajković, Andrea

Vrsta, podvrsta i kategorija rada
Ocjenski radovi, doktorska disertacija

Fakultet
Farmaceutsko-biokemijski fakultet

Mjesto
Zagreb

Datum
21.04

Godina
2023

Stranica
110

Mentor
Mucalo, Iva

Ključne riječi
comprehensive medication management services ; pharmaceutical care ; nonrandomised ; primary health care ; cardiovascular diseases ; older patients ; clinical outcomes ; health-related quality of life ; implementation stage ; budget impact analysis

Sažetak
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.

Izvorni jezik
Engleski

Znanstvena područja
Farmacija

POVEZANOST RADA