Patient preferences and cost-benefit of hypertension and hyperlipidemia collaborative management model between pharmacies and primary care in Portugal: A discrete choice experiment alongside a trial (USFarmácia®).

Autor: Costa S; NOVA National School of Public Health (ENSP), Universidade NOVA de Lisboa, Lisboa, Portugal.; Institute for Evidence-Based Health (ISBE), Lisboa, Portugal.; Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal., Guerreiro J; Centre for Health Evaluation & Research (CEFAR), Infosaúde, Associação Nacional das Farmácias, Lisboa, Portugal., Teixeira I; Centre for Health Evaluation & Research (CEFAR), Infosaúde, Associação Nacional das Farmácias, Lisboa, Portugal., Helling DK; Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Denver, Colorado, United States of America., Mateus C; Health Economics at Lancaster, Division of Health Research, Lancaster University, Lancaster, United Kingdom., Pereira J; NOVA National School of Public Health (ENSP), Universidade NOVA de Lisboa, Lisboa, Portugal.; Public Health Research Centre (PHRC/CISP), Comprehensive Health Research Centre (CHRC), Lisboa, Portugal.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2023 Oct 05; Vol. 18 (10), pp. e0292308. Date of Electronic Publication: 2023 Oct 05 (Print Publication: 2023).
DOI: 10.1371/journal.pone.0292308
Abstrakt: Background: Little is known about patient preferences and the value of pharmacy-collaborative disease management with primary care using technology-driven interprofessional communication under real-world conditions. Discrete Choice Experiments (DCEs) are useful for quantifying preferences for non-market services.
Objectives: 1) To explore variation in patient preferences and estimate willingness-to-accept annual cost to the National Health Service (NHS) for attributes of a collaborative intervention trial between pharmacies and primary care using a trial exit DCE interview; 2) to incorporate a DCE into an economic evaluation using cost-benefit analysis (CBA).
Methods: We performed a DCE telephone interview with a sample of hypertension and hyperlipidemia trial patients 12 months after trial onset. We used five attributes (levels): waiting time to get urgent/not urgent medical appointment (7 days/45 days; 48 hrs./30 days; same day/15 days), model of pharmacy intervention (5-min. counter basic check; 15-min. office every 3 months for BP and medication review of selected medicines; 30-min. office every 6 months for comprehensive measurements and medication review of all medicines), integration with primary care (weak; partial; full), chance of having a stroke in 5 years (same; slightly lower; much lower), and annual cost to the NHS (0€; 30€; 51€; 76€). We used an experimental orthogonal fractional factorial design. Data were analyzed using conditional logit. We subtracted the estimated annual incremental trial costs from the mean WTA (Net Benefit) for CBA.
Results: A total of 122 patients completed the survey. Waiting time to get medical appointment-on the same day (urgent) and within 15 days (non-urgent)-was the most important attribute, followed by 30-minute pharmacy intervention in private office every 6 months for point-of-care measurements and medication review of all medicines, and full integration with primary care. The cost attribute was not significant. Intervention patients were willing to accept the NHS annual cost of €877 for their preferred scenario. The annual net benefit per patient is €788.20 and represents the monetary value of patients' welfare surplus for this model.
Conclusions: This study is the first conducted in Portugal alongside a pharmacy collaborative trial, incorporating DCE into CBA. The findings can be used to guide the design of pharmacy collaborative interventions with primary care with the potential for reimbursement for uncontrolled or at-risk chronic disease patients informed by patient preferences. Future DCE studies conducted in community pharmacy may provide additional contributions.
Trial Registration: Current Controlled Trials (ISRCTN): ISRCTN13410498, retrospectively registered on 12 December 2018.
Competing Interests: The funder provided support in the form of salaries for authors SC, JG, and IT. DKH has given talks on US innovative pharmacist-led collaborative interventions in Portugal for which travel, and accommodation costs have been reimbursed by ANF. CM and JP declare that they have no known conflicts of interest. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
(Copyright: © 2023 Costa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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