The Feasibility of a Fast-Track Cardiovascular Medication Refill Model in a Hong Kong Cardiology Outpatient Clinic

Background: This study aimed to evaluate the cost-effectiveness and patient acceptance of a fast-track medication refill (FTMR) service whereby pharmacists and nurses recommend cardiovascular medication refills for stable patients requiring no medication change.It also aimed to create a model that would able to predict which patients are suitable for the FTMR service.Methods: 472 patients were reviewed between April 2016 and March 2017.For each patient, data were collected on demographics, medical history, symptoms, vital signs, and laboratory results.These data were used to build logistic regression models able to predict whether a patient required medication change.Interviews were conducted with 92 patients to evaluate the time costs, financial costs, patient acceptance, and clinical need for an FTMR service.A cost-effectiveness analysis was performed to estimate the potential cost saving from the introduction of an FTMR service. Results:The mean age of the study population was 58.7±12.4years.Among the sample of cardiology patients, 89.4% were on anti-hypertensives; 25.6% were on hypoglycemics, and 59.8% were on cholesterol-lowering drugs.The majority (79%) of patients had no prescription changes recorded during the study period.Our predictive model demonstrated an accuracy level of >96% in the identification of the 50.6% of the cohort judged by physician consultation to be in stable condition, requiring no medication change or dose adjustment.Of the patients requiring no medication change, 53.6% agreed to use the FTMR service.Our analysis found that the FTMR service could lead to savings of 289 USD per 10 person-years, assuming each patient attended a follow-up visit every 6 months. Conclusion:Within our cardiology clinic, a significant number of outpatients were eligible and willing to utilize an FTMR service, which was found to be a cost-effective improvement.Step-down care of stable patients may help to alleviate the increasing demands and pressure on healthcare providers.