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Twigg, Michael J. 
ORCID: https://orcid.org/0000-0003-0910-3850, Wright, David, Barton, Garry, Kirkdale, Charlotte L. and Thornley, Tracey
(2019)
The pharmacy care plan service: Service evaluation and estimate of cost-effectiveness.
Research in Social and Administrative Pharmacy, 15 (1).
pp. 84-92.
ISSN 1551-7411
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Abstract
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 - -1; p=0.002) and diastolic blood pressure (mean difference -1.81 mmHg; 95% CI -2.8 - -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 £8,495. 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.
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