| Authors and date |
Aims |
Pharmacy Service/Intervention |
Methods |
Main measures |
Outcomes/main findings |
| Green & McCloskey (2005)19 |
To describe and characterise the provision of multicompartment compliance aids and medicine reminder charts in UK hospitals; to investigate the transfer of information about these between secondary and primary care and to investigate methods of remuneration for MCA supply in primary care |
MCAs |
|
|
Funding for MCA by community pharmacists was reported to be unknown (61%), 7 day prescriptions (28.4%), MCA fees (9%), the patient (2%) Information about the MCA was reported to be communicated to the patient’s community pharmacist by 66 (49.2%) hospitals; of these, various methods of communicating this information included telephone call (52%), fax (45%), letter for patient to take to community pharmacy (17%), letter mailed directly to community pharmacy (14%)
|
| Nunney & Raynor (2001)20 |
To assess the scale of dispensing in compliance aids to patients at home, how community pharmacists provide this service and whether patients’ needs are met |
MCAs |
|
Self-completion questionnaire to all pharmacists in the Leeds Health Authority Administered questionnaire to 10 pharmacists who provide MCAs Administered questionnaire to all patients from the 10 selected pharmacies
|
95 (77%) of all pharmacists used MCAs General practitioners and hospital staff were the main initiators of requests for an MCA 10 (18%) patients had difficulty using the MCA device 52 (93%) patients thought the MCA was better than conventional containers 22 (39%) of patients thought they would be able to remember to take their medicines if still in conventional containers
|
| Ryan-Woolley & Rees (2005)21
|
To assess medication wastage using a “medicines organiser (MO)” |
MCAs |
Exploratory controlled-matched study 62 sheltered housing residents aged 60 or over in the North West of England Intervention group: received MO Control group: standard packaging
|
|
Intervention group wastage reduced from 18.1% baseline to 1% at 12 months (no statistical significance reported) No data available for control group participants as they did not return any unused medicines to the pharmacist.
|
| Carr et al. (2007)22 |
To determine the effectiveness of a community pharmacist intervention to promote effective use of emollients in children with atopic eczema |
Education |
|
Telephone-administered questionnaire Primary outcome: current severity of the symptoms (itch, irritability, sleep disturbance and skin appearance)
|
Increase in correct application of creams (significance not reported) Small significant reduction in itch (p=0.001) and irritability (p=0.006) but little reduction in sleep deprivation (p=0.44) or skin appearance (p=0.09)
|
| Nazareth et al. (2001)23 |
To investigate the effectiveness of a pharmacy discharge plan in elderly hospitalised patients |
Community pharmacy involvement in discharge |
|
Primary outcome: readmission to hospital Secondary outcomes included adherence, assessed via a semi-structured interview. Other secondary outcomes: number of deaths, attendance at hospital outpatient clinics and general practice, global patient well-being, satisfaction with the service, knowledge about medication
|
No significant differences between the intervention and control groups in readmission to hospital at 3 months (39% vs. 39.2%, respectively, difference = 0.18 (95%CI: -10.6 to 10.2) or 6 months (27.9% vs. 28.4%, respectively, difference = 0.54 (95%CI: -11 to 9.9%) No significant difference in mean (SD) adherence scores between intervention and control group patients at 3 months [0.75 (0.3) vs. 0.75 (0.28), respectively] or 6 months [0.78 (0.3) vs. 0.78 (0.3), respectively)
|
| Blenkinsopp et al. (2000)24
|
To assess the effect of a patient-centred intervention by community pharmacists on adherence to treatment for hypertension |
Tailored intervention |
Randomised controlled trial 20 community pharmacy sites (11 intervention and 9 controls) in one health authority in England 180 patients with hypertension (101 intervention and 79 control)
|
Blood pressure (BP) control Self-reported adherence, measured using a modified version of the Medication Adherence Report Scale (MARS).30 Patient satisfaction with pharmaceutical services, based on an adapted version of a scale developed in the United States by MacKeigan and Larson.31,32
|
For patients whose BP was uncontrolled prior to the study (n=28 in intervention group and n=35 in the control group), intervention group patients were more likely to have improved control at follow up than control group patients: 10 (35.7%) vs. 6 (17.1%), respectively (p <0.05) Self reported adherence was significantly higher in the intervention group compared to control group; 62.9% vs. 50%, respectively (p <0.05) An increased level of satisfaction with pharmacy services was reported by intervention patients regarding the “explanation” and “consideration” aspects of their pharmacist’s intervention
|
| Raynor et al. (2000)25
|
To develop and evaluate an adherence support service by community pharmacists for elderly patients living at home |
Tailored intervention |
Before and after study 6 community pharmacists in the city of Leeds, England 143 patients aged 65 or over, prescribed 4 or more medicines and living alone
|
Number of prescribed regular medicines Knowledge of purpose of medicines Number and nature of medicine-related problems Self-reported adherence measured using items developed by Horne30 and Morisky.33 Cost of medication
|
A significant reduction in the number of patients who reported one or more medicine-related problems at follow-up from 94% to 58% (P<0.001) The proportion of patients responding “rarely” or “never” to the five statements about non-adherence increased from 62% to 86% (p<0.001) The number of patients with medication related problems was significantly reduced and self reported adherence significantly increased. The cost of medication fell more than the cost of the pharmacist providing the service
|
| Clifford et al. (2006)26
|
To assess the effect of pharmacists giving advice to meet patients’ needs after starting a new medicine for a chronic condition |
Tailored intervention |
Randomised controlled trial 500 patients Patients aged 75 or over with a first prescription for a medication for stroke, cardiovascular disease, asthma, diabetes or arthritis
|
Primary outcome: self-reported adherence (defined as missing at least one dose of the new medicine within the last 7 days) Secondary outcomes included: number of medicine-related problems and beliefs about the medicine (the latter assessed using the Beliefs about Medicines Questionnaire)34
|
Non-adherence was significantly lower in the intervention group (9%) compared to the control (16%), p=0.032 Medication related problems were significantly lower in the intervention group (23%) compared to the control group (34%), p=0.021 Beliefs about medicines were more positive in the intervention group patients compared to control; mean scores 5 vs. 3.5, respectively (p=0.007)
|
| Elliott et al. (2008)27
|
To assess the cost-effectiveness of pharmacists giving advice via telephone to patients receiving a new medicine for a chronic condition |
Tailored intervention |
As per the Clifford et al study above |
Outcome measures as per the Clifford et al study above NHS resource use data (NHS contact, pharmacist training and time) were collected for each patient 6 weeks after the intervention (unit costs for 2004/5 were used). Incremental cost effectiveness ratios (ICERS) were generated
|
The intervention was cost effective compared to the control group Mean total patient costs at follow-up (median, range) were intervention group: GBP187.7 (40.6, 4.2-2484.3); control group: GBP282.8 (42, 0-3804), p<0.0001
|
