The MEDMAN study

A randomized controlled trial of community pharmacy-led medicines management for patients with coronary heart disease

Mariesha Jaffray, Christine Margaret Bond, Margaret Camilla Watson, Philip Christopher Hannaford, Michela Tinelli, Anthony Scott, Amanda Jane Lee, Alison Blenkinsopp, Claire Anderson, Anthony Avery, Paul Bissell

Research output: Contribution to journalArticle

97 Citations (Scopus)

Abstract

Background. There have been recent moves to extend the role of the community pharmacist to include medicine management.

Methods. A randomized controlled trial was conducted in nine sites in England. Patients with coronary heart disease were identified from general practice computer systems, recruited and randomized (2:1) to intervention or control. The 12-month intervention comprised an initial consultation with a community pharmacist to review appropriateness of therapy, compliance, lifestyle, social and support issues. Control patients received standard care. The primary outcome measures were appropriate treatment [derived from the National Service Framework (NSF)], health status (SF-36, EQ-5D) and an economic evaluation. Secondary outcome measures were patient risk of cardiovascular death and satisfaction.

Results. The study involved 1493 patients (980 intervention and 513 control), 62 pharmacists and 164 GPs. No statistically significant differences between intervention and control groups were shown at follow-up for any of the primary outcome measures such as numbers on aspirin or lifestyle measures. There were few differences in quality of life (SF-36) between the intervention and control groups at baseline or follow-up or with overall EQ-5D score over time. The total National Health Service cost increased between baseline and at 12 months in both groups but to a greater extent in the intervention group. Significant improvements were found in the satisfaction score for patients' most recent pharmacy visit for prescription medicines among the intervention group, compared with control group. Self-reported compliance was good for both groups at baseline and no significant differences were shown at follow-up.

Conclusion. There was no change in the proportion of patients receiving appropriate medication as defined by the NSF. The pharmacist-led service was more expensive than standard care.
Original languageEnglish
Pages (from-to)189-200
Number of pages12
JournalFamily Practice
Volume24
Issue number2
DOIs
Publication statusPublished - 1 Apr 2007

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Pharmacies
Coronary Disease
Pharmacists
Randomized Controlled Trials
Outcome Assessment (Health Care)
Control Groups
Compliance
Life Style
Regional Health Planning
Computer Systems
National Health Programs
Patient Satisfaction
Social Support
General Practice
England
Health Care Costs
Aspirin
Health Status
Cost-Benefit Analysis
Prescriptions

Cite this

Jaffray, Mariesha ; Bond, Christine Margaret ; Watson, Margaret Camilla ; Hannaford, Philip Christopher ; Tinelli, Michela ; Scott, Anthony ; Lee, Amanda Jane ; Blenkinsopp, Alison ; Anderson, Claire ; Avery, Anthony ; Bissell, Paul. / The MEDMAN study : A randomized controlled trial of community pharmacy-led medicines management for patients with coronary heart disease. In: Family Practice. 2007 ; Vol. 24, No. 2. pp. 189-200.
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abstract = "Background. There have been recent moves to extend the role of the community pharmacist to include medicine management.Methods. A randomized controlled trial was conducted in nine sites in England. Patients with coronary heart disease were identified from general practice computer systems, recruited and randomized (2:1) to intervention or control. The 12-month intervention comprised an initial consultation with a community pharmacist to review appropriateness of therapy, compliance, lifestyle, social and support issues. Control patients received standard care. The primary outcome measures were appropriate treatment [derived from the National Service Framework (NSF)], health status (SF-36, EQ-5D) and an economic evaluation. Secondary outcome measures were patient risk of cardiovascular death and satisfaction.Results. The study involved 1493 patients (980 intervention and 513 control), 62 pharmacists and 164 GPs. No statistically significant differences between intervention and control groups were shown at follow-up for any of the primary outcome measures such as numbers on aspirin or lifestyle measures. There were few differences in quality of life (SF-36) between the intervention and control groups at baseline or follow-up or with overall EQ-5D score over time. The total National Health Service cost increased between baseline and at 12 months in both groups but to a greater extent in the intervention group. Significant improvements were found in the satisfaction score for patients' most recent pharmacy visit for prescription medicines among the intervention group, compared with control group. Self-reported compliance was good for both groups at baseline and no significant differences were shown at follow-up.Conclusion. There was no change in the proportion of patients receiving appropriate medication as defined by the NSF. The pharmacist-led service was more expensive than standard care.",
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Jaffray, M, Bond, CM, Watson, MC, Hannaford, PC, Tinelli, M, Scott, A, Lee, AJ, Blenkinsopp, A, Anderson, C, Avery, A & Bissell, P 2007, 'The MEDMAN study: A randomized controlled trial of community pharmacy-led medicines management for patients with coronary heart disease', Family Practice, vol. 24, no. 2, pp. 189-200. https://doi.org/10.1093/fampra/cml075

The MEDMAN study : A randomized controlled trial of community pharmacy-led medicines management for patients with coronary heart disease. / Jaffray, Mariesha; Bond, Christine Margaret; Watson, Margaret Camilla; Hannaford, Philip Christopher; Tinelli, Michela; Scott, Anthony; Lee, Amanda Jane; Blenkinsopp, Alison; Anderson, Claire; Avery, Anthony; Bissell, Paul.

In: Family Practice, Vol. 24, No. 2, 01.04.2007, p. 189-200.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The MEDMAN study

T2 - A randomized controlled trial of community pharmacy-led medicines management for patients with coronary heart disease

AU - Jaffray, Mariesha

AU - Bond, Christine Margaret

AU - Watson, Margaret Camilla

AU - Hannaford, Philip Christopher

AU - Tinelli, Michela

AU - Scott, Anthony

AU - Lee, Amanda Jane

AU - Blenkinsopp, Alison

AU - Anderson, Claire

AU - Avery, Anthony

AU - Bissell, Paul

PY - 2007/4/1

Y1 - 2007/4/1

N2 - Background. There have been recent moves to extend the role of the community pharmacist to include medicine management.Methods. A randomized controlled trial was conducted in nine sites in England. Patients with coronary heart disease were identified from general practice computer systems, recruited and randomized (2:1) to intervention or control. The 12-month intervention comprised an initial consultation with a community pharmacist to review appropriateness of therapy, compliance, lifestyle, social and support issues. Control patients received standard care. The primary outcome measures were appropriate treatment [derived from the National Service Framework (NSF)], health status (SF-36, EQ-5D) and an economic evaluation. Secondary outcome measures were patient risk of cardiovascular death and satisfaction.Results. The study involved 1493 patients (980 intervention and 513 control), 62 pharmacists and 164 GPs. No statistically significant differences between intervention and control groups were shown at follow-up for any of the primary outcome measures such as numbers on aspirin or lifestyle measures. There were few differences in quality of life (SF-36) between the intervention and control groups at baseline or follow-up or with overall EQ-5D score over time. The total National Health Service cost increased between baseline and at 12 months in both groups but to a greater extent in the intervention group. Significant improvements were found in the satisfaction score for patients' most recent pharmacy visit for prescription medicines among the intervention group, compared with control group. Self-reported compliance was good for both groups at baseline and no significant differences were shown at follow-up.Conclusion. There was no change in the proportion of patients receiving appropriate medication as defined by the NSF. The pharmacist-led service was more expensive than standard care.

AB - Background. There have been recent moves to extend the role of the community pharmacist to include medicine management.Methods. A randomized controlled trial was conducted in nine sites in England. Patients with coronary heart disease were identified from general practice computer systems, recruited and randomized (2:1) to intervention or control. The 12-month intervention comprised an initial consultation with a community pharmacist to review appropriateness of therapy, compliance, lifestyle, social and support issues. Control patients received standard care. The primary outcome measures were appropriate treatment [derived from the National Service Framework (NSF)], health status (SF-36, EQ-5D) and an economic evaluation. Secondary outcome measures were patient risk of cardiovascular death and satisfaction.Results. The study involved 1493 patients (980 intervention and 513 control), 62 pharmacists and 164 GPs. No statistically significant differences between intervention and control groups were shown at follow-up for any of the primary outcome measures such as numbers on aspirin or lifestyle measures. There were few differences in quality of life (SF-36) between the intervention and control groups at baseline or follow-up or with overall EQ-5D score over time. The total National Health Service cost increased between baseline and at 12 months in both groups but to a greater extent in the intervention group. Significant improvements were found in the satisfaction score for patients' most recent pharmacy visit for prescription medicines among the intervention group, compared with control group. Self-reported compliance was good for both groups at baseline and no significant differences were shown at follow-up.Conclusion. There was no change in the proportion of patients receiving appropriate medication as defined by the NSF. The pharmacist-led service was more expensive than standard care.

KW - Clinical outcomes

KW - community pharmacy

KW - Coronary heart disease

KW - RCT

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U2 - 10.1093/fampra/cml075

DO - 10.1093/fampra/cml075

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JF - Family Practice

SN - 0263-2136

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