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Original research
‘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
  1. Rachel Ann Elliott1,
  2. Matthew J Boyd2,
  3. Lukasz Tanajewski3,
  4. Nick Barber4,
  5. Georgios Gkountouras1,
  6. Anthony J Avery5,
  7. Rajnikant Mehta6,
  8. James E Davies7,
  9. Nde-Eshimuni Salema8,
  10. Christopher Craig9,
  11. Asam Latif10,
  12. Justin Waring11,
  13. Antony Chuter12
  1. 1 Manchester Centre for Health Economics, School of Health Sciences, University of Manchester, Manchester, UK
  2. 2 Division of Pharmacy Practice and Policy, University of Nottingham School of Pharmacy, Nottingham, UK
  3. 3 Department of Economics, Kozminski University, Warsaw, Poland
  4. 4 School of Pharmacy, UCL School of Pharmacy, London, UK
  5. 5 Primary Care, University of Nottingham, Nottingham, UK
  6. 6 School of Medicine and Dentistry, University of Birmingham, Birmingham, UK
  7. 7 School of Pharmacy, Health Bridge, London, UK
  8. 8 School of Medicine, University of Nottingham, Nottingham, UK
  9. 9 Institute of Mental Health, CLAHRC East Midlands, Nottingham, UK
  10. 10 School of Health Sciences, University of Nottingham, Nottingham, UK
  11. 11 Nottingham University Business School, University of Nottingham, Nottingham, UK
  12. 12 School of Pharmacy, 68 Brighton Cottages, Haywards Heath, UK
  1. Correspondence to Professor Rachel Ann Elliott, Manchester Centre for Health Economics, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK; rachel.a.elliott{at}manchester.ac.uk

Abstract

Objective To examine the effectiveness and cost-effectiveness of the community pharmacy New Medicine Service (NMS) at 26 weeks.

Methods Pragmatic 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).

Results Unadjusted 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.

Conclusions At 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 number NCT01635361, ISRCTN23560818, ISRCTN23560818, UKCRN12494.

  • compliance
  • cost-effectiveness
  • decision analysis
  • randomised controlled trial
  • pharmacists
https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjqs-2018-009177

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    Footnotes

    • Funding This study was funded by the Department of Health Policy Research Programme.

    • Disclaimer The views expressed in this article are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The National Research Ethics Service (NRES) West Midlands-Black Country Research Ethics Committee (12/WM/0096), 2 May 2012.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request.

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