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首页> 外文期刊>Journal of primary care & community health. >Improving the Care of Dual Eligible Patients in Rural Federally Qualified Health Centers: The Impact of Care Coordinators and Clinical Pharmacists
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Improving the Care of Dual Eligible Patients in Rural Federally Qualified Health Centers: The Impact of Care Coordinators and Clinical Pharmacists

机译：改善农村有联邦资格的健康中心的双重合格患者的护理：护理协调员和临床药师的影响

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Background: Dual eligible persons are those covered by both Medicare and Medicaid. There were 9.6 million dual eligible persons in the United States and 82 000 in West Virginia in 2010. Dual eligibles are poorer, sicker, and more burdened with serious mental health conditions than Medicare or Medicaid patients as a whole. Their health care costs are significantly higher and they are more likely to receive fragmented ineffective care. Purpose: To improve the care experience and health care outcomes of dual eligible patients by the expanded use of care coordinators and clinical pharmacists. Methods: During 2012, 3 rural federally qualified community health centers in West Virginia identified 200 dual eligible patients each. Those with hospitalizations received more frequent care coordinator contacts. Those on more than 15 chronic medications had drug utilization reviews with recommendations to primary care providers. Baseline measures included demographics, chronic diseases, total medications and Beers list medications, hospitalization, and emergency room (ER) use in the previous year. Postintervention measures included hospitalization, ER use, total medications, and Beers list medications. Results: Out of 556 identified patients, 502 were contacted and enrolled. Sixty-five percent were female. The median age was 69 years, with a range of 29 to 93 years. Nineteen percent (19%) of patients were on 15 or more medications, 56% on psychotropic medication/and 33% on chronic opiates. One site showed reductions of 34% in hospitalizations and 25% in ER visits during the intervention year. For all sites combined, there was a 5.5% reduction in total medications and a 14.8% reduction in Beers list medications. Conclusions: A modest investment in care coordination and clinical pharmacy review can produce significant reductions in hospitalization and harmful polypharmacy for community dwelling dual eligible patients.
机译：背景：符合双重条件的人员是医疗保险和医疗补助所涵盖的人员。 2010年，美国有960万双重合格人口，西维吉尼亚州为82000。双重合格人口比整体Medicare或Medicaid患者更贫穷，病情更重，精神疾病严重。他们的医疗保健费用高得多，他们更有可能接受零散的无效医疗保健。目的：通过扩大使用护理协调员和临床药剂师的方式，改善具有双重资格的患者的护理经验和保健结果。方法：2012年，西弗吉尼亚州的3个获得联邦联邦政府认证的农村社区健康中心分别确定了200名双重合格患者。那些住院患者得到了更频繁的护理协调员联系。那些使用超过15种慢性药物的患者进行了药物利用率审查，并向初级保健提供者推荐。基准指标包括人口统计，慢性病，总用药和比尔清单上的用药，住院和急诊室（ER）的使用情况。干预后的措施包括住院，急诊室使用，总用药和比尔清单药物。结果：在556名已确定的患者中，有502名被联系并入组。 65％是女性。中位年龄为69岁，范围为29至93岁。 19％（19％）的患者使用15种或以上药物，56％的精神药物/ 33％的慢性阿片类药物。在干预年中，有一个站点的住院率下降了34％，急诊就诊率下降了25％。对于所有场所，总用药量减少了5.5％，比尔清单上的药物减少了14.8％。结论：在护理协调和临床药房审查方面的少量投资可以显着减少社区双重居住条件患者的住院和有害多药治疗。

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