The Pharmaceutical Journal
Vol 273 No 7319 p458
2 October 2004

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BPC 2004 News summary

Limited benefit from pharmacists’ interventions

Intervention by community pharmacists taking part in the Community Pharmacy Medicines Management project did not lead to more appropriate treatment in patients with coronary heart disease. However, 84 per cent of patients were satisfied or very satisfied with the medicines management service.

The findings of this randomised controlled trial, which involved 1,334 patients, 50 pharmacies and 39 GP practices, were presented at the British Pharmaceutical Conference in Manchester this week. The project was funded by the Department of Health and managed by a number of pharmacy organisations.

Pharmacists carried out a face-to-face medication review of patients with CHD identified for participation in the study from GP records. Pharmacists assessed the clinical appropriateness of patients’ drug regimens according to the National Service Framework for CHD. They also explored patients’ beliefs and concerns about their medicines, and compliance and lifestyle issues. Following the initial consultation, pharmacists could decide whether patients needed further formal consultations or opportunistic follow up. All pharmacists participated in training on CHD.

According to the evaluation team, led by Aberdeen university, the main reason for a lack of impact was that patients were already on optimal treatment and were well managed with regard to lifestyle issues. This left little opportunity for pharmacists to make an intervention. However, in a sample of 169 patients the researchers found that community pharmacists only picked up 34 per cent of problems identified by an academic GP and a clinical pharmacist. “We need to determine how we can improve this,” said Christine Bond, professor of primary care, University of Aberdeen, and a member of the evaluation team.

The researchers said that barriers to the success of the project included a lack of time and facilities in pharmacies, as well as a lack of access to patient records and lack of remuneration. Patient feedback showed that most patients preferred to see their GP. “We were looking for a holistic, concordant model of care but most patients preferred a paternalistic approach,” said Alison Blenkinsopp, professor of medicines management, Keele University, also involved in the project.

Most GPs gave positive feedback about the project. Pharmacists believed that the project had changed their practice and made them more knowledgeable.