General practitioner practice-based pharmacist input to medicines optimisation in the UK: pragmatic, multicenter, randomised, controlled trial

Nadia Farhanah Syafhan; Sayer Al Azzam; Steven D. Williams; Wendy Wilson; Jayne Brady; Peter Lawrence; Mark McCrudden; Mustafa Ahmed; Michael G. Scott; Glenda Fleming; Anita Hogg; Claire Scullin; Robert Horne; Harblas Ahir; James C. McElnay

doi:10.1186/s40545-020-00279-3

General practitioner practice-based pharmacist input to medicines optimisation in the UK: pragmatic, multicenter, randomised, controlled trial

Nadia Farhanah Syafhan, Sayer Al Azzam, Steven D. Williams, Wendy Wilson, Jayne Brady, Peter Lawrence, Mark McCrudden, Mustafa Ahmed, Michael G. Scott, Glenda Fleming, Anita Hogg, Claire Scullin, Robert Horne, Harblas Ahir, James C. McElnay^*

^*Corresponding author for this work

School of Pharmacy

Research output: Contribution to journal › Article › peer-review

2 Citations (Scopus)

67 Downloads (Pure)

Abstract

Background: Changing demographics across the UK has led to general practitioners (GPs) managing increasing numbers of older patients with multi-morbidity and resultant polypharmacy. Through government led initiatives within the National Health Service, an increasing number of GP practices employ pharmacist support. The purpose of this study is to evaluate the impact of a medicines optimisation intervention, delivered by GP practice-based pharmacists, to patients at risk of medication-related problems (MRPs), on patient outcomes and healthcare costs. Methods: A multi-centre, randomised (normal care or pharmacist supplemented care) study in four regions of the UK, involving patients (n = 356) from eight GP practices, with a 6-month follow-up period. Participants were adult patients who were at risk of MRPs. Results: Median number of MRPs per intervention patient were reduced at the third assessment, i.e. 3 to 0.5 (p < 0.001) in patients who received the full intervention schedule. Medication Appropriateness Index (MAI) scores were reduced (medications more appropriate) for the intervention group, but not for control group patients (8 [4–13] to 5 [0–11] vs 8 [3–13] to 7 [3–12], respectively; p = 0.001). Using the intention-to-treat (ITT) approach, the number of telephone consultations in intervention group patients was reduced and different from the control group (1 [0–3] to 1 [0–2] vs 1 [0–2] to 1 [0–3], p = 0.020). No significant differences between groups were, however, found in unplanned hospital admissions, length of hospital stay, number of A&E attendances or outpatient visits. The mean overall healthcare cost per intervention patient fell from £1041.7 ± 1446.7 to £859.1 ± 1235.2 (p = 0.032). Cost utility analysis showed an incremental cost per patient of − £229.0 (95% CI − 594.6, 128.2) and a mean QALY gained of 0.024 (95% CI − 0.021 to 0.065), i.e. indicative of a health status gain at a reduced cost (2016/2017). Conclusion: The pharmacist service was effective in reducing MRPs, inappropriateness of medications and telephone consultations in general practice in a cost-effective manner. Trial registration: ClinicalTrials.Gov, NCT03241498. Registered 7 August 2017—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03241498

Original language	English
Article number	4
Journal	Journal of Pharmaceutical Policy and Practice
Volume	14
Issue number	1
DOIs	https://doi.org/10.1186/s40545-020-00279-3
Publication status	Published - 04 Jan 2021

Bibliographical note

Funding Information:
The authors wish to thank to patients who participated; research leads for Northern Health and Social Care Trust (NHSCT), Northern Ireland (Dianne Gill), North West Coast Academic Health Science Network (AHSN), England (Andy Cairns and Andy Shakeshaft), Wessex AHSN, England (Claire Howard and Vicki Rowse), Eastern AHSN, England (Carol Roberts and Paula Wilkinson); practice staff at the Ballymoney Family Practice, Family Practice Antrim Health Centre, Westbourne Medical Centre, The Adam Practice, Pendle View Medical Centre, Wingate Medical Centre, Fern House Surgery and Douglas Grove Surgery; Colette Goldrick, Association of the British Pharmaceutical Industry (ABPI) for her encouragement and support throughout the study and finally the ABPI and the Indonesia Endowment Fund for Education (LPDP) for financial support.

Funding Information:
This study was partially funded by Association of the British Pharmaceutical Industry (ABPI) (grant number MOIC001). NFS was sponsored by the Indonesia Endowment Fund for Education (LPDP) (20160422046233).

Publisher Copyright:
© 2021, The Author(s).

Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.

Keywords

Clinical pharmacist
General practice
Healthcare resource utilisation
Medicines optimisation
Practice-based pharmacist

ASJC Scopus subject areas

Pharmacology, Toxicology and Pharmaceutics(all)
Health Policy

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1186/s40545-020-00279-3Licence: CC BY

General practitioner practice-based pharmacist input to medicines optimisation in the UK: pragmatic, multicenter, randomised, controlled trial
Copyright 2021 the authors. This is an open access article published under a Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium, provided the author and source are cited.
Final published version, 1.72 MBLicence: CC BY

Contemporary challenges in clinical pharmacy practice - medicines optimisation and medication adherence
Author: Syafhan, N., Dec 2020
Supervisor: Parsons, C. (Supervisor), McElnay, J. (Supervisor) & Scott, M. (Supervisor)
Student thesis: Doctoral Thesis › Doctor of Philosophy

Cite this

Syafhan, N. F., Al Azzam, S., Williams, S. D., Wilson, W., Brady, J., Lawrence, P., McCrudden, M., Ahmed, M., Scott, M. G., Fleming, G., Hogg, A., Scullin, C., Horne, R., Ahir, H., & McElnay, J. C. (2021). General practitioner practice-based pharmacist input to medicines optimisation in the UK: pragmatic, multicenter, randomised, controlled trial. Journal of Pharmaceutical Policy and Practice, 14(1), [4]. https://doi.org/10.1186/s40545-020-00279-3

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abstract = "Background: Changing demographics across the UK has led to general practitioners (GPs) managing increasing numbers of older patients with multi-morbidity and resultant polypharmacy. Through government led initiatives within the National Health Service, an increasing number of GP practices employ pharmacist support. The purpose of this study is to evaluate the impact of a medicines optimisation intervention, delivered by GP practice-based pharmacists, to patients at risk of medication-related problems (MRPs), on patient outcomes and healthcare costs. Methods: A multi-centre, randomised (normal care or pharmacist supplemented care) study in four regions of the UK, involving patients (n = 356) from eight GP practices, with a 6-month follow-up period. Participants were adult patients who were at risk of MRPs. Results: Median number of MRPs per intervention patient were reduced at the third assessment, i.e. 3 to 0.5 (p < 0.001) in patients who received the full intervention schedule. Medication Appropriateness Index (MAI) scores were reduced (medications more appropriate) for the intervention group, but not for control group patients (8 [4–13] to 5 [0–11] vs 8 [3–13] to 7 [3–12], respectively; p = 0.001). Using the intention-to-treat (ITT) approach, the number of telephone consultations in intervention group patients was reduced and different from the control group (1 [0–3] to 1 [0–2] vs 1 [0–2] to 1 [0–3], p = 0.020). No significant differences between groups were, however, found in unplanned hospital admissions, length of hospital stay, number of A&E attendances or outpatient visits. The mean overall healthcare cost per intervention patient fell from £1041.7 ± 1446.7 to £859.1 ± 1235.2 (p = 0.032). Cost utility analysis showed an incremental cost per patient of − £229.0 (95% CI − 594.6, 128.2) and a mean QALY gained of 0.024 (95% CI − 0.021 to 0.065), i.e. indicative of a health status gain at a reduced cost (2016/2017). Conclusion: The pharmacist service was effective in reducing MRPs, inappropriateness of medications and telephone consultations in general practice in a cost-effective manner. Trial registration: ClinicalTrials.Gov, NCT03241498. Registered 7 August 2017—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03241498",

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note = "Funding Information: The authors wish to thank to patients who participated; research leads for Northern Health and Social Care Trust (NHSCT), Northern Ireland (Dianne Gill), North West Coast Academic Health Science Network (AHSN), England (Andy Cairns and Andy Shakeshaft), Wessex AHSN, England (Claire Howard and Vicki Rowse), Eastern AHSN, England (Carol Roberts and Paula Wilkinson); practice staff at the Ballymoney Family Practice, Family Practice Antrim Health Centre, Westbourne Medical Centre, The Adam Practice, Pendle View Medical Centre, Wingate Medical Centre, Fern House Surgery and Douglas Grove Surgery; Colette Goldrick, Association of the British Pharmaceutical Industry (ABPI) for her encouragement and support throughout the study and finally the ABPI and the Indonesia Endowment Fund for Education (LPDP) for financial support. Funding Information: This study was partially funded by Association of the British Pharmaceutical Industry (ABPI) (grant number MOIC001). NFS was sponsored by the Indonesia Endowment Fund for Education (LPDP) (20160422046233). Publisher Copyright: {\textcopyright} 2021, The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.",

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doi = "10.1186/s40545-020-00279-3",

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Syafhan, NF, Al Azzam, S, Williams, SD, Wilson, W, Brady, J, Lawrence, P, McCrudden, M, Ahmed, M, Scott, MG, Fleming, G, Hogg, A, Scullin, C, Horne, R, Ahir, H & McElnay, JC 2021, 'General practitioner practice-based pharmacist input to medicines optimisation in the UK: pragmatic, multicenter, randomised, controlled trial', Journal of Pharmaceutical Policy and Practice, vol. 14, no. 1, 4. https://doi.org/10.1186/s40545-020-00279-3

TY - JOUR

T1 - General practitioner practice-based pharmacist input to medicines optimisation in the UK: pragmatic, multicenter, randomised, controlled trial

AU - Syafhan, Nadia Farhanah

AU - Al Azzam, Sayer

AU - Williams, Steven D.

AU - Wilson, Wendy

AU - Brady, Jayne

AU - Lawrence, Peter

AU - McCrudden, Mark

AU - Ahmed, Mustafa

AU - Scott, Michael G.

AU - Fleming, Glenda

AU - Hogg, Anita

AU - Scullin, Claire

AU - Horne, Robert

AU - Ahir, Harblas

AU - McElnay, James C.

N1 - Funding Information: The authors wish to thank to patients who participated; research leads for Northern Health and Social Care Trust (NHSCT), Northern Ireland (Dianne Gill), North West Coast Academic Health Science Network (AHSN), England (Andy Cairns and Andy Shakeshaft), Wessex AHSN, England (Claire Howard and Vicki Rowse), Eastern AHSN, England (Carol Roberts and Paula Wilkinson); practice staff at the Ballymoney Family Practice, Family Practice Antrim Health Centre, Westbourne Medical Centre, The Adam Practice, Pendle View Medical Centre, Wingate Medical Centre, Fern House Surgery and Douglas Grove Surgery; Colette Goldrick, Association of the British Pharmaceutical Industry (ABPI) for her encouragement and support throughout the study and finally the ABPI and the Indonesia Endowment Fund for Education (LPDP) for financial support. Funding Information: This study was partially funded by Association of the British Pharmaceutical Industry (ABPI) (grant number MOIC001). NFS was sponsored by the Indonesia Endowment Fund for Education (LPDP) (20160422046233). Publisher Copyright: © 2021, The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.

PY - 2021/1/4

Y1 - 2021/1/4

N2 - Background: Changing demographics across the UK has led to general practitioners (GPs) managing increasing numbers of older patients with multi-morbidity and resultant polypharmacy. Through government led initiatives within the National Health Service, an increasing number of GP practices employ pharmacist support. The purpose of this study is to evaluate the impact of a medicines optimisation intervention, delivered by GP practice-based pharmacists, to patients at risk of medication-related problems (MRPs), on patient outcomes and healthcare costs. Methods: A multi-centre, randomised (normal care or pharmacist supplemented care) study in four regions of the UK, involving patients (n = 356) from eight GP practices, with a 6-month follow-up period. Participants were adult patients who were at risk of MRPs. Results: Median number of MRPs per intervention patient were reduced at the third assessment, i.e. 3 to 0.5 (p < 0.001) in patients who received the full intervention schedule. Medication Appropriateness Index (MAI) scores were reduced (medications more appropriate) for the intervention group, but not for control group patients (8 [4–13] to 5 [0–11] vs 8 [3–13] to 7 [3–12], respectively; p = 0.001). Using the intention-to-treat (ITT) approach, the number of telephone consultations in intervention group patients was reduced and different from the control group (1 [0–3] to 1 [0–2] vs 1 [0–2] to 1 [0–3], p = 0.020). No significant differences between groups were, however, found in unplanned hospital admissions, length of hospital stay, number of A&E attendances or outpatient visits. The mean overall healthcare cost per intervention patient fell from £1041.7 ± 1446.7 to £859.1 ± 1235.2 (p = 0.032). Cost utility analysis showed an incremental cost per patient of − £229.0 (95% CI − 594.6, 128.2) and a mean QALY gained of 0.024 (95% CI − 0.021 to 0.065), i.e. indicative of a health status gain at a reduced cost (2016/2017). Conclusion: The pharmacist service was effective in reducing MRPs, inappropriateness of medications and telephone consultations in general practice in a cost-effective manner. Trial registration: ClinicalTrials.Gov, NCT03241498. Registered 7 August 2017—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03241498

AB - Background: Changing demographics across the UK has led to general practitioners (GPs) managing increasing numbers of older patients with multi-morbidity and resultant polypharmacy. Through government led initiatives within the National Health Service, an increasing number of GP practices employ pharmacist support. The purpose of this study is to evaluate the impact of a medicines optimisation intervention, delivered by GP practice-based pharmacists, to patients at risk of medication-related problems (MRPs), on patient outcomes and healthcare costs. Methods: A multi-centre, randomised (normal care or pharmacist supplemented care) study in four regions of the UK, involving patients (n = 356) from eight GP practices, with a 6-month follow-up period. Participants were adult patients who were at risk of MRPs. Results: Median number of MRPs per intervention patient were reduced at the third assessment, i.e. 3 to 0.5 (p < 0.001) in patients who received the full intervention schedule. Medication Appropriateness Index (MAI) scores were reduced (medications more appropriate) for the intervention group, but not for control group patients (8 [4–13] to 5 [0–11] vs 8 [3–13] to 7 [3–12], respectively; p = 0.001). Using the intention-to-treat (ITT) approach, the number of telephone consultations in intervention group patients was reduced and different from the control group (1 [0–3] to 1 [0–2] vs 1 [0–2] to 1 [0–3], p = 0.020). No significant differences between groups were, however, found in unplanned hospital admissions, length of hospital stay, number of A&E attendances or outpatient visits. The mean overall healthcare cost per intervention patient fell from £1041.7 ± 1446.7 to £859.1 ± 1235.2 (p = 0.032). Cost utility analysis showed an incremental cost per patient of − £229.0 (95% CI − 594.6, 128.2) and a mean QALY gained of 0.024 (95% CI − 0.021 to 0.065), i.e. indicative of a health status gain at a reduced cost (2016/2017). Conclusion: The pharmacist service was effective in reducing MRPs, inappropriateness of medications and telephone consultations in general practice in a cost-effective manner. Trial registration: ClinicalTrials.Gov, NCT03241498. Registered 7 August 2017—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03241498

KW - Clinical pharmacist

KW - General practice

KW - Healthcare resource utilisation

KW - Medicines optimisation

KW - Practice-based pharmacist

U2 - 10.1186/s40545-020-00279-3

DO - 10.1186/s40545-020-00279-3

M3 - Article

AN - SCOPUS:85098647322

VL - 14

JO - Journal of Pharmaceutical Policy and Practice

JF - Journal of Pharmaceutical Policy and Practice

SN - 2052-3211

IS - 1

M1 - 4

ER -

General practitioner practice-based pharmacist input to medicines optimisation in the UK: pragmatic, multicenter, randomised, controlled trial

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

UN SDGs

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Student theses

Contemporary challenges in clinical pharmacy practice - medicines optimisation and medication adherence

Cite this