Objective To determine whether home based medication review by pharmacists affects hospital readmission rates among older people. Design Randomised controlled trial. Setting Home based medication review after discharge from acute or community hospitals in Norfolk and Suffolk. Participants 872 patients aged over 80 recruited during an emergency admission (any cause) if returning to own home or warden controlled accommodation and taking two or more drugs daily on discharge. Intervention Two home visits by a pharmacist within two weeks and eight weeks of discharge to educate patients and carers about their drugs, remove out of date drugs, inform general practitioners of drug reactions or interactions, and inform the local pharmacist if a compliance aid is needed. Control arm received usual care. Main outcome measure Total emergency readmissions to hospital at six months. Secondary outcomes included death and quality of life measured with the EQ-5D. Results By six months 178 readmissions had occurred in the control group and 234 in the intervention group (rate ratio = 1.30, 95% confidence interval 1.07 to 1.58; P = 0.009, Poisson model). 49 deaths occurred in the intervention group compared with 63 in the control group (hazard ratio = 0.75, 0.52 to 1.10; P = 0.14). EQ-5D scores decreased (worsened) by a mean of 0.14 in the control group and 0.13 in the intervention group (difference = 0.01, − 0.05 to 0.06; P = 0.84, t test). Conclusions The intervention was associated with a significantly higher rate of hospital admissions and did not significantly improve quality of life or reduce deaths. Further research is needed to explain this counterintuitive finding and to identify more effective methods of medication review.

The aim of this study was to examine the potential differences between beliefs relating to symptomatic and preventive inhaler treatment and to analyze the relationship between these beliefs and the use of inhalers by adult patients with asthma in general practice. Unstructured interviews with a stratified sample of 8 patients, taking a combination of salbutamol and beclomethasone inhalers, were used to develop themes for a structured interview, where questions relating to 8 main areas of interest were measured on a 5-point Likert scale. Forty patients prescribed the same combination of inhalers were randomly selected for the structured interview. All agreed to participate (100% response). Correlations between the responses to the 8 themes and measures of inhaler use were analyzed. High use of salbutamol for the relief of symptoms and low use of beclomethasone for the prevention of asthma were common. Perceived benefits of the inhalers, a positive attitude to using the inhalers, and concern about side effects had strong influences on the use of both inhalers. Uncertainty about the inhalers, a negative attitude to using the inhalers, and the involvement of others in asthma management had less influence on inhaler use. Satisfaction with the doctor and the ease of obtaining an inhaler were more important issues for beclomethasone use than for salbutamol use. There are important differences in the beliefs that patients hold in relation to symptomatic and preventive use of inhaler treatment. These findings suggest that focusing on very specific attitudes to treatment may be of benefit in the health education of adults with asthma. Further work is planned to refine the themes so that doctors will be able to explore patients' views about their inhaler treatment by asking a few direct questions.

SummaryThis 12-month retrospective pilot study analysed prescription data of 82 patients with asthma from six practices in Norfolk. Patients on an inhaled corticosteroid/long-acting beta-agonist combination inhaler had significantly greater adherence to inhaled corticosteroids compared to those on a corticosteroid inhaler alone (72.2% versus 40.5%, p=0.001).

Objective: To develop a valid and reliable questionnaire to assess patients' beliefs about inhaler treatment for asthma. Design: A structured interview in which patients' beliefs about inhalers were individually rated. Factor analysis of those beliefs that had the highest correlations with estimated inhaler use. Setting and subjects: A stratified random sample of 40 patients taking a combination of salbutamol and beclomethasone dipropionate in one general practice. Results: Six factors explained 67.7% of the variance relating to beclomethasone dipropionate use: positive beliefs about the inhaler, satisfaction with the repeat prescription system, dissatisfaction with the doctor, collecting inhalers, a preference for tablets and concern about side-effects. Seven factors explained 69.9% of the variance relating to salbutamol use: no faith in prevention, a dislike of inhalers, relying on regular salbutamol, lack of disability, a preference for tablets, making decisions about inhalers and inhalers not lasting long enough. Conclusions: Beliefs about inhaler treatment can be classified into relatively few factors that explain a significant proportion of the beliefs that relate to inhaler use. Development of the questionnaire is continuing to produce a valid questionnaire with reliable subscales.

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