Real-World Effectiveness in Hypertension and Hyperlipidemia Collaborative Management Between Pharmacies and Primary Care in Portugal: A Multicenter Quasi-Experimental Pragmatic Controlled Trial (USFarmácia®)
Author(s)
Costa S1, Biscaia JL2, Horta MR3, Romano S4, Guerreiro J4, Heudtlass P4, Cary M5, Romão M4, Rodrigues A4, Miranda A6, Martins AP7, Bento AS2, Pereira J8, Mateus C9, Helling DK10
1Institute for Evidence-Based Health (ISBE), Lisboa, Portugal, 2USF S. Julião da Figueira, Agrupamento dos Centros de Saúde (ACeS) do Baixo Mondego, Figueira da Foz, Portugal, 3Centre for Medicines Information and Health Interventions (CEDIME), Infosaúde, National Association of Pharmacies, Lisboa, Portugal, 4Centre for Health Evaluation & Research (CEFAR), Infosaúde, National Association of Pharmacies (ANF), Lisboa, Portugal, 5Centre for Health Evaluation & Research (CEFAR), Infosaúde, National Association of Pharmacies (ANF), Lisbon, Portugal, 6National Oncology Registry (RON), Portuguese Oncology Institute of Lisbon Francisco Gentil (IPOLFG), Lisboa, Portugal, 7Faculty of Pharmacy of the University of Lisbon, Lisboa, Portugal, 8Escola Nacional de Saúde Pública (ENSP), Universidade NOVA de Lisboa, Lisboa, 11, Portugal, 9Lancaster University, Lancaster, UK, 10Skaggs School of Pharmacy & Pharmaceutical Sciences University of Colorado, Denver, CO, USA
Presentation Documents
OBJECTIVES:
To assess the effectiveness and discuss the design and challenges of hypertension and hyperlipidemia management between pharmacies and primary care in Portugal in real-world conditions using data exchange and experimental bundled payment.METHODS:
Pragmatic, quasi-experimental 6-month controlled trial. We collected patient-level data from pharmacy dispensing software; primary care prescribing and clinical software, and patient telephone surveys. The primary outcomes were changes in blood pressure and total cholesterol. We used: 1) Difference-in-differences (DiD) estimators in a GLM; 2) Controlled Interrupted Time Series (CITS).RESULTS:
A total of 27 pharmacists from 7 intervention pharmacies, 6 physicians, and 6 nurses from the intervention primary care unit (USF) plus 5 best match control USFs and 13 control pharmacies participated. A total of 203 patients entered the study and were included in the baseline analysis for the telephone survey. The number of patients in the primary care database was 107 for the 6-months prior to recruitment and 114 for the 6-month following recruitment. After adjusting for covariates in GLM, we were not able to observe significant differences in the effect of intervention vs control in our sample population or subgroups either. When using CITS, the trend effect in systolic BP change although negative (-0.43 mmHg) is not significant either. We experienced several challenges which required creative strategies in real-time after the onset of the trial. We collected additional data for economic and qualitative studies.CONCLUSIONS:
This trial was not able to show effectiveness due to the limitations in primary care technology. It offers, however, valuable learnings on innovative methods, strategies, and real-world evidence from various data sources, and paves the way to improve future real-world trials to advance integrated care between pharmacies and primary care. Trial Registration: Current Controlled Trials (ISRCTN): ISRCTN13410498, retrospectively registered on 12 December 2018: https://www.isrctn.com/ISRCTN13410498Conference/Value in Health Info
Value in Health, Volume 25, Issue 12S (December 2022)
Code
HSD67
Topic
Clinical Outcomes, Medical Technologies, Study Approaches
Topic Subcategory
Clinical Outcomes Assessment
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)