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
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...
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| Format: | Article |
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BMJ Publishing Group
2016
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| Online Access: | https://eprints.nottingham.ac.uk/42892/ |
| _version_ | 1848796594732793856 |
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| author | Elliott, Rachel Ann Boyd, Matthew J. Salema, Nde-Eshimuni Davies, James Barber, Nicholas Mehta, Rajnikant Laxmishanker Tanajewski, Lukasz Waring, Justin Latif, Asam Gkountouras, Georgios Avery, A.J. Chuter, Antony Craig, Christopher |
| author_facet | Elliott, Rachel Ann Boyd, Matthew J. Salema, Nde-Eshimuni Davies, James Barber, Nicholas Mehta, Rajnikant Laxmishanker Tanajewski, Lukasz Waring, Justin Latif, Asam Gkountouras, Georgios Avery, A.J. Chuter, Antony Craig, Christopher |
| author_sort | Elliott, Rachel Ann |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| description | 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. |
| first_indexed | 2025-11-14T19:50:28Z |
| format | Article |
| id | nottingham-42892 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| last_indexed | 2025-11-14T19:50:28Z |
| publishDate | 2016 |
| publisher | BMJ Publishing Group |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | nottingham-428922020-05-04T18:08:18Z https://eprints.nottingham.ac.uk/42892/ 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 Elliott, Rachel Ann Boyd, Matthew J. Salema, Nde-Eshimuni Davies, James Barber, Nicholas Mehta, Rajnikant Laxmishanker Tanajewski, Lukasz Waring, Justin Latif, Asam Gkountouras, Georgios Avery, A.J. Chuter, Antony Craig, Christopher 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. BMJ Publishing Group 2016-10-01 Article PeerReviewed Elliott, Rachel Ann, Boyd, Matthew J., Salema, Nde-Eshimuni, Davies, James, Barber, Nicholas, Mehta, Rajnikant Laxmishanker, Tanajewski, Lukasz, Waring, Justin, Latif, Asam, Gkountouras, Georgios, Avery, A.J., Chuter, Antony and Craig, Christopher (2016) 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. BMJ Quality & Safety, 25 (10). pp. 747-758. ISSN 2044-5423 http://qualitysafety.bmj.com/content/25/10/747 doi:10.1136/bmjqs-2015-004400 doi:10.1136/bmjqs-2015-004400 |
| spellingShingle | Elliott, Rachel Ann Boyd, Matthew J. Salema, Nde-Eshimuni Davies, James Barber, Nicholas Mehta, Rajnikant Laxmishanker Tanajewski, Lukasz Waring, Justin Latif, Asam Gkountouras, Georgios Avery, A.J. Chuter, Antony Craig, Christopher 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 |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| url | https://eprints.nottingham.ac.uk/42892/ https://eprints.nottingham.ac.uk/42892/ https://eprints.nottingham.ac.uk/42892/ |