Safety and prescribing quality
Evaluation of Supplementary Prescribing by Nurses and Pharmacists
The evaluation of supplementary prescribing by nurses and pharmacists, a significant study, which has informed both policy and practice. Claire Anderson worked on this Department of Health Policy Unit funded study with colleagues from CSRHHC and ScHARR at University of Sheffield.
The study aimed to:
- assess the barriers and the factors facilitating supplementary prescribing by nurses and pharmacists
- identify the impact of supplementary prescribing on patient experiences, professional practice and costs to the NHS
- inform policy for current and future nurse and pharmacist prescribers.
This large study used in depth interviews, surveys, PACT data analysis, observational case studies and patient safety assessment instruments.
This is the final report: An Evaluation of Supplementary Prescribing in Nursing and Pharmacy (PDF)
Evaluation of Patient Reporting to the Yellow Card System
Claire Anderson lead on qualitative research for the HTA evaluation of patient reporting of adverse drug reactions (HTA, DH) with colleagues from Sociology, Primary Care Primary Care at Aberdeen and Drug Safety Research Unit. http://eprints.nottingham.ac.uk/1514/1/Patient_reporting_of_ADRS.pdf
This mixed methods study
- evaluate the pharmacovigilance impact of patient reporting to the Yellow Card System
- report on patient experiences of the Yellow Card System
- assess public awareness of being able to report
- offer recommendations for improvements to patient reporting based on our research findings and literature from other countries.
This large study incorporated a questionnaire, telephone interviews, an omnibus survey, usability testing and qualitative and quantitative evaluation of patient and health professional yellow card reports.
Community Pharmacy Medicines Management Project (MEDMAN)
The evaluation of the Community Pharmacy Medicines Management Project (MEDMAN) has been undertaken, forming one of the largest studies of the practice of pharmacy in the UK (DH,PSNC: with Universities of Aberdeen and Keele).
A randomised controlled trial was conducted in nine sites in England. Qualitative research explored the experiences of patients, pharmacists and GPs with the trial. The study involved 1493 patients (980 intervention, 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 EQ5-D score over time.
The total NHS 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. 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. Patients were satisfied with the service and satisfaction with their most recent pharmacy visit was statistically significantly higher in the intervention compared with the control group. Patients in the intervention group also received significantly more information from the community pharmacist about side effects of their medication, their health and had statistically significantly better understanding of how to take their medicines compared with controls.
GPs remained broadly supportive of the service but after the intervention almost all of them (98%) believed the community pharmacists needed access to medical records to deliver a medicines management service. Community Pharmacists felt more knowledgeable about CHD and clinical pharmacy in general and reported being more likely to discuss prescribed medicines with patients. Fifty percent of community pharmacists also reported that their relationship with GPs had improved.The overall levels of pharmacist activity were similar to those reported in other studies, and individual pharmacists in this study recommended optimal treatment. There is a clear need to understand the reasons why an effective service was not universally delivered and to learn from the examples of good practice.
THE COMMUNITY PHARMACY MEDICINES MANAGEMENT PROJECT EVALUATION TEAM, 2007. The MEDMAN Study: A Randomized Controlled Trial of Community Pharmacy-led Medicines Management for Patients with Coronary Heart Disease. Family Practice, 24(2), 189-200.
SCOTT, A., TINELLI, M. and BOND, C., on behalf of the Community Pharmacy Medicines Management Project Evaluation Team. A Community Pharmacist-led Medicines Management Service for Patients with Coronary Heart Disease (CHD): Cost Minimization Analysis. Pharmacoeconomics (in press).
JAFFRAY, M., KRSKA, J. and BOND, C., on behalf of the Community Pharmacy Medicines Management Project Evaluation Team. The MEDMAN Project: Evaluation of the Medicines Management Training for Community Pharmacists. Pharmacy Education Manuscript ID: 238087 (in press).
PINCER Trial
Two multicentre RCTs (Elliott) focus on safety, prescribing quality and efficiency: PINCER, an RCT to reduce error rates in general practices (Patient Safety Research Programme, with Manchester, Edinburgh) and TARGET, an RCT to examine impact of TPMT genotyping, prior to commencement of azathioprine (DoH, with Manchester).
A recent notable project in the theme of safety and efficiency modelled NSAIDs and COX-2 inhibitors in longer term use, research urgently required as published trial data do not provide head-to-head comparisons (Elliott, Rheumatology 2006; 45: 606, abstracted in: Research Highlights: Nature Clinical Practice Rheumatology (2006) 2, 406).
Primary head-to-head comparisons of the quality and efficiency of medicines have been carried out in cystic fibrosis (Elliott, Thorax 2004; 59: 242) and anaesthesia (DH; with Manchester and Wirral, Elliott, Anaesthesia 2003; 58: 412), both the largest studies carried out to date in their therapeutic field.
Current modelling studies in the themes of safety and efficiency are use of glycopeptides in MRSA prophylaxis (Elliott, DH; with York) and prevention of osteoporosis in JIA (Elliott, DH; with Manchester and Belfast).