Effectiveness of telephone counselling by pharmacists.
The study by Wu et al showed that a telephone service by pharmacists in Hong Kong could improve adherence and reduce mortality. Readers in other countries may wonder whether this work is generalizable across different cultures and health care systems. We can provide some evidence that it is, and that the service is cost effective.
We have conducted a similar study in the UK 1 targeted at people starting chronic therapy, when non-adherence can develop rapidly2. It was a theory driven, randomized controlled trial of 500 patients, the intervention group receiving a telephone call from a pharmacist 2 weeks after starting a new medicine for a chronic condition. At 4-week follow-up non adherence was significantly lower in the intervention group compared to control (9% vs 16%, p=0.03), as were the number of patients reporting problems with their medicines (23% vs 34%, p=0.02). Patients’ attitudes towards their medicines (known to be related to adherence3,4) were measured by the ‘necessity-concerns differential’3 (an indicator of how the patient judges their perceived need for the medication relative to their concerns about potential adverse effects). The differential was significantly more positive in the intervention group when compared to control (5.0 vs 3.5, p=0.007). Phone calls took a median of 12 minutes.
An economic evaluation, led by Elliott, will be published separately; the cost effectiveness acceptability curve shows there is an 86% chance that the intervention is dominant - less costly and more effective than normal treatment. In short, we would expect the intervention to be cost effective in the UK.
References
1. Clifford S, Barber N, Elliott R, Hartley E, Horne R. Patient centred advice is effective in improving adherence to medicines. Pharmacy World and Science (2006); e-publication DOI 10.1007/s11096-006-9026-6 Available from: http://www.springerlink.com/content/m31612w6648l6722/ [accessed 28th September 2006]
2. Barber,N., Parsons,J., Clifford,S., Darracott,R., and Horne,R., Patients' problems with new medication for chronic conditions. Quality and Safety in Health Care (2004); 13: 172-5.
3. Horne R, Weinman J. Patients' beliefs about prescribed medicines and their role inadherence to treatment in chronic physical illness - processes and applications. Journal of Psychosomatic Research (1999); 47(6):555-567.
4. Horne R, Weinman J. Self regulation and self management in asthma: Exploring the role of illness perceptions and treatment beliefs in explaining non-adherence to preventer medication. Psychology and Health (2002); 17(1):17-32.
Competing interests:
None declared
Competing interests:
No competing interests
30 September 2006
Nick Barber
Professor of the Practice of Pharmacy
Sarah Clifford, Rob Horne, Rachel Elliott (University of Manchester), and Elaine Hartley (Alliance Pharmacy)
Rapid Response:
Effectiveness of telephone counselling by pharmacists.
The study by Wu et al showed that a telephone service by pharmacists in Hong Kong could improve adherence and reduce mortality. Readers in other countries may wonder whether this work is generalizable across different cultures and health care systems. We can provide some evidence that it is, and that the service is cost effective.
We have conducted a similar study in the UK 1 targeted at people starting chronic therapy, when non-adherence can develop rapidly2. It was a theory driven, randomized controlled trial of 500 patients, the intervention group receiving a telephone call from a pharmacist 2 weeks after starting a new medicine for a chronic condition. At 4-week follow-up non adherence was significantly lower in the intervention group compared to control (9% vs 16%, p=0.03), as were the number of patients reporting problems with their medicines (23% vs 34%, p=0.02). Patients’ attitudes towards their medicines (known to be related to adherence3,4) were measured by the ‘necessity-concerns differential’3 (an indicator of how the patient judges their perceived need for the medication relative to their concerns about potential adverse effects). The differential was significantly more positive in the intervention group when compared to control (5.0 vs 3.5, p=0.007). Phone calls took a median of 12 minutes.
An economic evaluation, led by Elliott, will be published separately; the cost effectiveness acceptability curve shows there is an 86% chance that the intervention is dominant - less costly and more effective than normal treatment. In short, we would expect the intervention to be cost effective in the UK.
References
1. Clifford S, Barber N, Elliott R, Hartley E, Horne R. Patient centred advice is effective in improving adherence to medicines. Pharmacy World and Science (2006); e-publication DOI 10.1007/s11096-006-9026-6 Available from: http://www.springerlink.com/content/m31612w6648l6722/ [accessed 28th September 2006]
2. Barber,N., Parsons,J., Clifford,S., Darracott,R., and Horne,R., Patients' problems with new medication for chronic conditions. Quality and Safety in Health Care (2004); 13: 172-5.
3. Horne R, Weinman J. Patients' beliefs about prescribed medicines and their role inadherence to treatment in chronic physical illness - processes and applications. Journal of Psychosomatic Research (1999); 47(6):555-567.
4. Horne R, Weinman J. Self regulation and self management in asthma: Exploring the role of illness perceptions and treatment beliefs in explaining non-adherence to preventer medication. Psychology and Health (2002); 17(1):17-32.
Competing interests:
None declared
Competing interests: No competing interests