Pharmacy care programme cuts blood pressure in over-65s
A pharmacy care programme can lead to better adherence to medication
and improvements in blood pressure and cholesterol measures for patients
over the age of 65 years, a study published
online this week suggests (JAMA, 13 November 2006).
The US study involved 200 patients who participated in a two-month run-in
observational phase followed by a six-month intervention, consisting
of standardised medicines education, regular follow-up by pharmacists
and dispensing in monitored dosage systems. Following the intervention
phase, patients were randomised to continue with the pharmacy care programme
or revert back to “usual care” for an additional six months.
Participants were taking an average of nine long-term medicines.
Compared with the observational period, patients experienced improved
adherence to medication (61.2 per cent to 96.9 per cent; P<0.001),
reductions in systolic blood pressure (133.2mmHg to 129.9mmHg; P=0.02)
and reductions in low-density lipoprotein cholesterol (91.7mg/dl to 86.8mg/dl;
P=0.001) by the end of the intervention
period.
At the end of the randomisation period, patients receiving usual care
had lower adherence than those remaining on the pharmacy programme (69.1
per cent versus 95.5 per cent; P<0.001). Systolic blood pressure was
improved in the pharmacy group compared with the usual care group at
the end of the six-month comparison. However, no significant difference
was seen for cholesterol levels.
In an editorial (ibid), Ross Simpson, Jr, from the University of North
Carolina, Chapel Hill, discusses the study’s limitations. He says: “Because
the usual care group was the reference group, the two groups in the randomised
trial phase of the study had different levels of observation and different
frequency of visits to the health facility after randomisation, and patients
in the usual care group had an intervention that they had been receiving
for six months removed. … [This introduced] a potential observation
bias that favoured the intervention group, especially because adherence
is a behaviour and observing a behaviour influences the
behaviour.”
Alaster Rutherford, head of medicines management at Bristol Primary Care
Trust, commented on the study: “I think it is hugely important
for the development of community pharmacy service in the UK. The next
step from medicines use reviews should be for concordance packages linked
to specific medication regimens — this is generalisable research
and the profession needs to emphasis this potentially significant contribution
to public health.” |
The
Pharmaceutical Journal
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