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BMJ Qual Saf. 2016 Oct;25(10):747-58. doi: 10.1136/bmjqs-2015-004400. Epub 2015 Dec 8.

Supporting adherence for people starting a new medication for a long-term condition through community pharmacies: a pragmatic randomised controlled trial of the New Medicine Service.

Author information

1
School of Pharmacy, University of Nottingham, Nottingham, UK Division of Social Research in Medicines and Health, University of Nottingham School of Pharmacy, Nottingham, UK.
2
Division of Social Research in Medicines and Health, University of Nottingham School of Pharmacy, Nottingham, UK.
3
Department of Policy and Research, The Company Chemists' Association, London, UK.
4
Health Foundation, London, UK.
5
School of Medicine, University of Nottingham, Nottingham, UK.
6
Division of Social Research in Medicines and Health, University of Nottingham School of Pharmacy, Nottingham, UK School of Pharmacy, University of Nottingham, Nottingham, UK.
7
Nottingham University Business School, University of Nottingham, Nottingham, UK.
8
Division of Primary Care, School of Community Health Sciences, Primary Care, University of Nottingham, Nottingham, UK.
9
School of Pharmacy, University of Nottingham, Nottingham, UK.

Abstract

OBJECTIVE:

To examine the effectiveness of the New Medicine Service (NMS), a national community pharmacy service to support medicines-taking in people starting a new medicine for a long-term condition, compared with normal practice.

METHODS:

Pragmatic patient-level parallel randomised controlled trial, in 46 community pharmacies in England. Patients 1:1 block randomisation stratified by drug/disease group within each pharmacy. 504 participants (NMS: 251) aged 14 years and over, identified in the pharmacy on presentation of a prescription for asthma/chronic obstructive pulmonary disease, hypertension, type 2 diabetes or an anticoagulant/antiplatelet agent. NMS intervention: One consultation 7-14 days after presentation of prescription followed by another 14-21 days thereafter to identify problems with treatment and provide support if needed. Controls received normal practice. Adherence, defined as missing no doses without the advice of a medical professional in the previous 7 days, was assessed through patient self-report at 10 weeks. Intention-to-treat analysis was employed, with outcome adjusted for recruiting pharmacy, NMS disease category, age, sex and medication count. Cost to the National Health Service (NHS) was collected.

RESULTS:

At 10 weeks, 53 patients had withdrawn and 443 (85%) patients were contacted successfully by telephone. In the unadjusted analysis of 378 patients still taking the initial medicine, 61% (95% CI 54% to 67%) and 71% (95% CI 64% to 77%) patients were adherent in the normal practice and NMS arms, respectively (p=0.04 for difference). In the adjusted intention-to-treat analysis, the OR for increased adherence was 1.67 (95% CI 1.06 to 2.62; p=0.027) in favour of the NMS arm. There was a general trend to reduced NHS costs, albeit, statistically non-significant, for the NMS intervention: saving £21 (95% CI -£59 to £100, p=0.128) per patient.

CONCLUSIONS:

The NMS significantly increased the proportion of patients adhering to their new medicine by about 10%, compared with normal practice.

TRIAL REGISTRATION NUMBERS:

ClinicalTrials.gov trial reference number NCT01635361 (http://clinicaltrials.gov/ct2/show/NCT01635361). Current Controlled trials: trial reference number ISRCTN 23560818 (http://www.controlled-trials.com/ISRCTN23560818/; DOI 10.1186/ISRCTN23560818). UK Clinical Research Network (UKCRN) study 12494 (http://public.ukcrn.org.uk/Search/StudyDetail.aspx?StudyID=12494).

KEYWORDS:

Chronic disease management; Compliance; Patient-centred care; Pharmacists; Randomised controlled trial

PMID:
26647412
DOI:
10.1136/bmjqs-2015-004400
[Indexed for MEDLINE]
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