'New Medicine Service':supporting adherence in people starting a new medication for a long-term condition: 26-week follow-up of a pragmatic randomised controlled trial
| Autor: | Rajnikant Mehta, Asam Latif, Anthony J Avery, Lukasz Tanajewski, Justin Waring, Georgios Gkountouras, Antony Chuter, Nick Barber, James Davies, Christopher Craig, Nde-Eshimuni Salema, Matthew J. Boyd, Rachel Elliott |
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| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Cost effectiveness Cost-Benefit Analysis Pharmacy Community Pharmacy Services State Medicine Medication Adherence law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial Willingness to pay law Health care Humans Medicine 030212 general & internal medicine Medical prescription Aged business.industry 030503 health policy & services Health Policy Middle Aged Clinical trial England Economic evaluation Emergency medicine Female 0305 other medical science business Follow-Up Studies Program Evaluation |
| Zdroj: | Elliott, R A, Boyd, M J, Tanajewski, L, Barber, N, Gkountouras, G, Avery, A J, Mehta, R, Davies, J E, Salema, N-E, Craig, C, Latif, A, Waring, J & Chuter, A 2019, ' 'New Medicine Service' : supporting adherence in people starting a new medication for a long-term condition: 26-week follow-up of a pragmatic randomised controlled trial ', BMJ Quality and Safety . https://doi.org/10.1136/bmjqs-2018-009177 |
| DOI: | 10.1136/bmjqs-2018-009177 |
| Popis: | ObjectiveTo examine the effectiveness and cost-effectiveness of the community pharmacy New Medicine Service (NMS) at 26 weeks.MethodsPragmatic patient-level parallel randomised controlled trial in 46 English community pharmacies. 504 participants aged ≥14, identified in the pharmacy when presenting a prescription for a new medicine for predefined long-term conditions, randomised to receive NMS (n=251) or normal practice (n=253) (NMS intervention: 2 consultations 1 and 2 weeks after prescription presentation). Adherence assessed through patient self-report at 26-week follow-up. Intention-to-treat analysis employed. National Health Service (NHS) costs calculated. Disease-specific Markov models estimating impact of non-adherence combined with clinical trial data to calculate costs per extra quality-adjusted life-year (QALY; NHS England perspective).ResultsUnadjusted analysis: of 327 patients still taking the initial medicine, 97/170 (57.1%) and 103/157 (65.6%) (p=0.113) patients were adherent in normal practice and NMS arms, respectively. Adjusted intention-to-treat analysis: adherence OR 1.50 (95% CI 0.93 to 2.44, p=0.095), in favour of NMS. There was a non-significant reduction in 26-week NHS costs for NMS: −£104 (95% CI −£37 to £257, p=0.168) per patient. NMS generated a mean of 0.04 (95% CI −0.01 to 0.13) more QALYs per patient, with mean reduction in lifetime cost of −£113.9 (−1159.4, 683.7). The incremental cost-effectiveness ratio was −£2758/QALY (2.5% and 97.5%: −38 739.5, 34 024.2. NMS has an 89% probability of cost-effectiveness at a willingness to pay of £20 000 per QALY.ConclusionsAt 26-week follow-up, NMS was unable to demonstrate a statistically significant increase in adherence or reduction in NHS costs, which may be attributable to patient attrition from the study. Long-term economic evaluation suggested NMS may deliver better patient outcomes and reduced overall healthcare costs than normal practice, but uncertainty around this finding is high.Trial registration numberNCT01635361, ISRCTN23560818, ISRCTN23560818, UKCRN12494. |
| Databáze: | OpenAIRE |
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