PloS one · 2024
Are integrated care models associated with improved drug safety in Swiss primary care? an observational analysis using healthcare claims data.
СтатьяНаблюдательное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Farcher Renato, Graber Sereina M, Boes Stefan, Huber Carola A
Аннотация
BACKGROUND: Integrated care models (ICMs) might be an effective strategy to improve patients' quality of care. The aim of this study was to compare different ICMs such as family-doctor models, and a standard care model (SCM) regarding patients' drug safety in Swiss primary care.
METHODS: We performed an observational study using health insurance claims data from patients who were continuously enrolled in an ICM or in a SCM between 2020 and 2021. ICMs included family-doctor model (FDM), family-doctor model light (FDM-light) and the telemedicine model (TM). Drug safety was assessed by the prescription of potentially inappropriate proton pump-inhibitors (PIPPI), opioids (PIO), medications (PIM), and polypharmacy. Propensity-score-weighted multiple logistic regression models were used to examine the association between different types of ICMs and drug safety.
RESULTS: Patients in FDM had significantly lower odds of receiving PIPPI (OR, 0.86; CI 95%, 0.83-0.89), PIO (OR, 0.81; CI 95%, 0.76-0.85), PIM (OR, 0.94; CI 95%, 0.91-0.97), and polypharmacy (OR, 0.94; CI 95%, 0.91-0.97) compared to patients in SCM. Potentially inappropriate prescribing was also lower in patients in TM and partly in FDM-light than in SCM. Persons enrolled in FDM were less likely to receive PIM (OR, 0.93; CI 95%, 0.89-0.97) and polypharmacy (OR, 0.94; CI 95%, 0.90-0.99) than those in FDM-light, whereas the odds of receiving PIPPI and polypharmacy were higher in FDM than in TM.
CONCLUSION: ICMs were significantly associated with higher drug safety compared to SCM for most outcomes. Findings suggest that patients may benefit most from ICMs with a high degree of coordination or gatekeeping. ICM may represent an effective approach to improve patients' drug safety and, thus, to reduce the risk of adverse events.
METHODS: We performed an observational study using health insurance claims data from patients who were continuously enrolled in an ICM or in a SCM between 2020 and 2021. ICMs included family-doctor model (FDM), family-doctor model light (FDM-light) and the telemedicine model (TM). Drug safety was assessed by the prescription of potentially inappropriate proton pump-inhibitors (PIPPI), opioids (PIO), medications (PIM), and polypharmacy. Propensity-score-weighted multiple logistic regression models were used to examine the association between different types of ICMs and drug safety.
RESULTS: Patients in FDM had significantly lower odds of receiving PIPPI (OR, 0.86; CI 95%, 0.83-0.89), PIO (OR, 0.81; CI 95%, 0.76-0.85), PIM (OR, 0.94; CI 95%, 0.91-0.97), and polypharmacy (OR, 0.94; CI 95%, 0.91-0.97) compared to patients in SCM. Potentially inappropriate prescribing was also lower in patients in TM and partly in FDM-light than in SCM. Persons enrolled in FDM were less likely to receive PIM (OR, 0.93; CI 95%, 0.89-0.97) and polypharmacy (OR, 0.94; CI 95%, 0.90-0.99) than those in FDM-light, whereas the odds of receiving PIPPI and polypharmacy were higher in FDM than in TM.
CONCLUSION: ICMs were significantly associated with higher drug safety compared to SCM for most outcomes. Findings suggest that patients may benefit most from ICMs with a high degree of coordination or gatekeeping. ICM may represent an effective approach to improve patients' drug safety and, thus, to reduce the risk of adverse events.