Effectiveness of telephone counselling by a pharmacist in reducing mortality in patients receiving polypharmacy: randomised controlled trialBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.38905.447118.2F (Published 07 September 2006) Cite this as: BMJ 2006;333:522
- Jennifer Y F Wu, pharmacist1,
- Wilson Y S Leung, pharmacist1,
- Sophie Chang, assistant professor3,
- Benjamin Lee, pharmacist2,
- Benny Zee, director4,
- Peter C Y Tong, associate professor1,
- Juliana C N Chan, professor of medicine and therapeutics ()1
- 1 Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR
- 2 Department of Pharmacy, Prince of Wales Hospital
- 3 School of Pharmacy, Chinese University of Hong Kong
- 4 Centre for Clinical Trials, Chinese University of Hong Kong
- Correspondence to: J C N Chan
- Accepted 29 June 2006
Objective To investigate the effects of compliance and periodic telephone counselling by a pharmacist on mortality in patients receiving polypharmacy.
Design Two year randomised controlled trial.
Setting Hospital medical clinic.
Participants 502 of 1011 patients receiving five or more drugs for chronic disease found to be non-compliant at the screening visit were invited for randomisation to either the telephone counselling group (n = 219) or control group (n = 223) at enrolment 12-16 weeks later.
Main outcome measures Primary outcome was all cause mortality in randomised patients. Associations between compliance and mortality in the entire cohort of 1011 patients were also examined. Patients were defined as compliant with a drug if they took 80-120% of the prescribed daily dose. To calculate a compliance score for the whole treatment regimen, the number of drugs that the patient was fully compliant with was divided by the total number of prescribed drugs and expressed as a percentage. Only patients who complied with all recommended drugs were considered compliant (100% score).
Results 60 of the 502 eligible patients defaulted and only 442 patients were randomised. After two years, 31 (52%) of the defaulters had died, 38 (17%) of the control group had died, and 25 (11%) of the intervention group had died. After adjustment for confounders, telephone counselling was associated with a 41% reduction in the risk of death (relative risk 0.59, 95% confidence interval 0.35 to 0.97; P = 0.039). The number needed to treat to prevent one death at two years was 16. Other predictors included old age, living alone, rate of admission to hospital, compliance score, number of drugs for chronic disease, and non-treatment with lipid lowering drugs at screening visit. In the cohort of 1011 patients, the adjusted relative risk for death was 1.61 (1.05 to 2.48; P = 0.029) and 2.87 (1.80 to 2.57; P < 0.001) in patients with compliance scores of 34-66% and 0-33%, respectively, compared with those who had a compliance score of 67% or more.
Conclusion In patients receiving polypharmacy, poor compliance was associated with increased mortality. Periodic telephone counselling by a pharmacist improved compliance and reduced mortality.
Trial registration International Standard Randomised Controlled Trial Number Register: SRCTN48076318.
The structured questionnaire is on bmj.com
Thanks to Philip KT Li and MF Lau for their assistance. We thank all staff at the PWH Li Ka Shing Specialist Medical Clinic and Albert Cheung, our statistician, for study design and analyses. We thank Bryan Williams, University of Leicester, for critically appraising our paper. This paper is dedicated to the late Julian AJH Critchley for his inspiration and support.
Contributors JCNC conceptualised, designed, and coordinated the study and finalised the manuscript. JYFW conducted the study, collected and analysed all data, and drafted the manuscript. WYSL helped analyse data and write the paper. PCYT, BL, SC, and BZ gave advice and edited the manuscript. All authors read and approved the manuscript. JCNC is guarantor.
Funding Hong Kong Government Health Care and Promotion Fund (HSRC/HCPF grant 226103) and MSD international grant.
Competing interests JCNC and PCYT are investigators in clinical trials and research programmes sponsored by MSD. JCNC is also a member of the MSD Worldwide Diabetes Advisory Board.
Ethical approval Chinese University of Hong Kong clinical research ethics committee.