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A Cluster Randomized Controlled Trial of an Adapted U.S. Model of Pharmaceutical Care for Nursing Home Residents in Northern Ireland (Fleetwood Northern Ireland Study): A Cost-Effectiveness Analysis

Authors

  • Susan M. Patterson PhD,

    1. From the *Clinical and Practice Research Group, School of Pharmacy and Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom; Department of Epidemiology and Community Health, Virginia Commonwealth University, Richmond, Virginia; and §Clinical Research Support Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom.
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  • Carmel M. Hughes PhD,

    1. From the *Clinical and Practice Research Group, School of Pharmacy and Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom; Department of Epidemiology and Community Health, Virginia Commonwealth University, Richmond, Virginia; and §Clinical Research Support Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom.
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  • Chris Cardwell PhD,

    1. From the *Clinical and Practice Research Group, School of Pharmacy and Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom; Department of Epidemiology and Community Health, Virginia Commonwealth University, Richmond, Virginia; and §Clinical Research Support Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom.
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  • Kate L. Lapane PhD,

    1. From the *Clinical and Practice Research Group, School of Pharmacy and Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom; Department of Epidemiology and Community Health, Virginia Commonwealth University, Richmond, Virginia; and §Clinical Research Support Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom.
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  • Ashley M. Murray PhD,

    1. From the *Clinical and Practice Research Group, School of Pharmacy and Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom; Department of Epidemiology and Community Health, Virginia Commonwealth University, Richmond, Virginia; and §Clinical Research Support Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom.
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  • Grainne E. Crealey PhD

    1. From the *Clinical and Practice Research Group, School of Pharmacy and Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom; Department of Epidemiology and Community Health, Virginia Commonwealth University, Richmond, Virginia; and §Clinical Research Support Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom.
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Address correspondence to Prof. Carmel Hughes, Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, United Kingdom. E-mail: c.hughes@qub.ac.uk

Abstract

OBJECTIVES: To evaluate the cost-effectiveness of an adapted U.S. model of pharmaceutical care to improve psychoactive prescribing for nursing home residents in Northern Ireland (Fleetwood NI Study).

DESIGN: Economic evaluation alongside a cluster randomized controlled trial.

SETTING: Nursing homes in NI randomized to intervention (receipt of the adapted model of care; n=11) or control (usual care continued; n=11).

PARTICIPANTS: Residents aged 65 and older who provided informed consent (N=253; 128 intervention, 125 control) and who had full resource use data at 12 months.

INTERVENTION: Trained pharmacists reviewed intervention home residents' clinical and prescribing information for 12 months, applied an algorithm that guided them in assessing the appropriateness of psychoactive medication, and worked with prescribers (general practitioners) to make changes. The control homes received usual care in which there was no pharmacist intervention.

MEASUREMENTS: The proportion of residents prescribed one or more inappropriate psychoactive medications (according to standardized protocols), costs, and a cost-effectiveness acceptability curve. The latter two outcomes are the focus for this article.

RESULTS: The proportions of residents receiving inappropriate psychoactive medication at 12 months in the intervention and control group were 19.5% and 50.4%, respectively. The mean cost of healthcare resources used per resident per year was $4,923 (95% confidence interval (CI)=$4,206–5,640) for the intervention group and $5,053 (95% CI=$4,328–5,779) for the control group. The probability of the intervention being cost-effective was high, even at low levels of willingness to pay to avoid a resident receiving inappropriately prescribed psychoactive medication.

CONCLUSION: The Fleetwood NI model of care was more cost-effective than usual care.

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