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The Medicines Advice Service Evaluation (MASE): a randomised controlled trial of a pharmacist-led telephone based intervention designed to improve medication adherence
  1. Imogen Lyons1,
  2. Nicholas Barber2,
  3. David K Raynor3,
  4. Li Wei4
  1. 1UCL Interaction Centre, University College London, London, UK
  2. 2Health Foundation, London, UK
  3. 3School of Healthcare, University of Leeds, Leeds, UK
  4. 4Research Department of Practice and Policy, UCL School of Pharmacy, University College London, London, UK
  1. Correspondence to Dr Imogen Lyons, UCL Interaction Centre, University College London, 66-72 Gower Street, London WC1E 6BT, UK; imogen.lyons.11{at}ucl.ac.uk

Abstract

Aim To test the effectiveness of a tailored, pharmacist-led centralised advice service to improve adherence to patients on established medications.

Methods A parallel group randomised controlled trial was conducted. Patients prescribed at least one oral medication for type 2 diabetes and/or lipid regulation were eligible to participate. 677 patients of a mail-order pharmacy were recruited and randomised (340 intervention, 337 control). The intervention comprised two tailored telephone consultations with a pharmacist, 4–6 weeks apart, plus a written summary of the discussion and a medicines reminder chart. The primary outcome was self-reported adherence to medication at 6-month follow-up, collected via a postal questionnaire, analysed using generalised estimating equations. Secondary outcomes included prescription refill adherence, lipid and glycaemic control and patient satisfaction.

Results In intention-to-treat analysis 36/340 (10.6%) of the intervention group were non-adherent (<90% of medication taken in the past 7 days) at 6 months compared with 66/337 (19.6%) in the control group, yielding an unadjusted OR of 1.54 (95% CI 1.11 to 2.15, p=0.01). Analyses of dispensing data also showed that the odds of being classified as adherent (≥90%) were 60% greater for the intervention group compared with the control group (OR 1.60, 95% CI 1.14 to 2.24, p<0.01). In a subsample of patients who provided blood samples, glycaemic and lipid control did not differ significantly between groups (p=0.06 and p=0.24, respectively) but positive trends were observed. Ninety-two per cent of intervention group patients reported that they were satisfied with the service overall.

Conclusions A telephone intervention, led by a pharmacist and tailored to the individuals’ needs, can significantly improve medication adherence in patients with long-term conditions, using a mail-order pharmacy. Further work is needed to confirm a trend towards improved clinical outcome.

Trial registration number NCT01864239.

  • Randomised controlled trial
  • Patient-centred care
  • Pharmacists
  • Compliance
  • Reminders

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