Department of Practice and Policy, School of Pharmacy, University of London, 29/39 Brunswick Square, London, WC1N 1AX. (Email: [email protected])

Aims and objectives

Patients starting new medication for a chronic condition often have problems with their medicine, and a significant proportion quickly become non-adherent. The purpose of this study was to evaluate a novel, patient-centred service in which a pharmacist telephoned patients after they started a new chronic medication, to explore any medicine-related problems and to provide any necessary advice or information. The objectives of the study were to use a randomised-controlled trial (RCT) to assess the effect of the new service on adherence, number of medicine-related problems and satisfaction with information about their medication. The study also aimed to explore the safety and utility of the intervention, and patients' perspectives of the service.

Methods

Patients were recruited at community pharmacies across England and randomised to intervention or control groups. They were eligible if they had started a new medication for a chronic condition and were 75 or over or suffered stroke, cardiovascular disease, asthma, diabetes or rheumatoid arthritis. Two pharmacists delivered the intervention; they telephoned the patient two weeks after recruitment and used a semi-structured interview to explore patients' problems, adherence to the medication and whether they wanted any further medicine-related information. A researcher telephoned patients in both groups two weeks later. A questionnaire was then sent to patients to measure satisfaction with information about medicines and, for the intervention group, satisfaction with the pharmacist's consultation. An expert panel assessed 100 interventions to establish their safety and usefulness to the patient. Patients in the intervention group were asked at the researcher interview, whether they had found the new service to be useful.

Results

394 patients were recruited and consented from 44 pharmacies. Intervention telephone calls took a mean of 12 minutes (range 1-56). At the four-week interview, per-protocol analysis showed non-adherence in the intervention group (16/185, 8%) to be lower than in the control group (31/193, 16%), p = 0.030. Intention-to-treat analysis showed no significant difference (p = 0.735). The incidence of medicine-related problems in the intervention group (43/185, 23%) was lower than in the control group (66/193, 34%), p = 0.019. The questionnaire showed satisfaction with information about the actions and usage of the medicine was greater in the intervention group (mean 6.03) than the control group (mean 5.02), p = 0.005, although satisfaction with information about risks and problems was unchanged. The expert panel rated 61% of 100 sample interventions as helpful and 9% as unhelpful. They rated 87% of the 100 interventions as having no potential to cause harm, and scored the remainder as having a harm score of up to 1 on a scale of 0-10. At interview, 154 (78%) of patients who received the intervention said they found it useful, the remainder expressed neutral views.

Conclusions

Community pharmacists can, through a brief, telephone interview, deliver a safe, effective, useful service to patients newly started on medication for a chronic condition. The service improves adherence, reduces medicine-related problems and improves satisfaction with information on the use of medicines.