Patient-centred advice is effective in improving adherence to medicines
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To assess the effects of pharmacists giving advice to meet patients’ needs after starting a new medicine for a chronic condition.
A prospective health technology assessment including a randomised controlled trial of a pharmacist-delivered intervention to improve adherence using a centralised telephone service to patients at home in England. Patients were eligible for recruitment if they were receiving the first prescription for a newly prescribed medication for a chronic condition and were 75 or older or suffering from stroke, cardiovascular disease, asthma, diabetes or rheumatoid arthritis.
Main outcome measures
Incidence of non-adherence, problems with the new medicine, beliefs about the new medicine, safety and usefulness of the interventions.
Five hundred patients consented and were randomised. At 4-week follow-up, non-adherence was significantly lower in the intervention group compared to control (9% vs. 16%, P = 0.032). The number of patients reporting medicine-related problems was significantly lower in the intervention group compared to the control (23% vs. 34%, P = 0.021). Intervention group patients also had more positive beliefs about their new medicine, as shown by their higher score on the “necessity-concerns differential” (5.0 vs. 3.5, P = 0.007). The phone calls took a median of 12 min each. Most advice was judged by experts to be safe and helpful, and patients found it useful.
Overall, these findings show benefits from pharmacists meeting patients’ needs for information and advice on medicines, soon after starting treatment. While a substantially larger trial would be needed to confirm that the effect is real and sustained, these initial findings suggest the service may be safe and useful to patients.
KeywordsChronic disease England Patient adherence Patient needs Pharmacist Randomized controlled trial Telephone service
We would like to thank the many who helped us: Intervention pharmacists: Helen Smurthwaite, Glen Savage. Expert panel: Imogen Savage, Mike Schachter, Colin Bradley, John Benson, Marie Miller. Statistical advice: Colin Chalmers. This work was undertaken by Professor N Barber and colleagues who received funding from the DHSC London, Research & Development, Responsive Funding Programme. The views expressed in the publication are those of the authors and not necessarily those of the National Health Service or the Department of Health.
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