A pilot study to assess the practicality, acceptability and feasibility of a randomised controlled trial to evaluate the impact of a pharmacist complex intervention on patients with stroke in their own homes

Abstract

This version is available at https://strathprints.strath.ac.uk/58503/ Strathprints is designed to allow users to access the research output of the University of Strathclyde. Unless otherwise explicitly stated on the manuscript, Copyright © and Moral Rights for the papers on this site are retained by the individual authors and/or other copyright owners. Please check the manuscript for details of any other licences that may have been applied. You may not engage in further distribution of the material for any profitmaking activities or any commercial gain. You may freely distribute both the url (https://strathprints.strath.ac.uk/) and the content of this paper for research or private study, educational, or not-for-profit purposes without prior permission or charge.Any correspondence concerning this service should be sent to the Strathprints administrator: strathprints@strath.ac.ukThe Strathprints institutional repository (https://strathprints.strath.ac.uk) is a digital archive of University of Strathclyde research outputs. It has been developed to disseminate open access research outputs, expose data about those outputs, and enable the management and persistent access to Strathclyde's intellectual output. Title PageA pilot study to assess the practicality, acceptability and feasibility of a randomised controlled trial to evaluate the impact of a pharmacist complex intervention to stroke patients in their own homes. Abstract ObjectiveTo test the practicality, acceptability and feasibility of recruitment, data collection, blood pressure monitoring and pharmaceutical care processes, in order to inform the design of a definitive randomised controlled trial of a pharmacist complex intervention to stroke patients in their own homes. MethodsPatients with new stroke from acute, rehabilitation wards and a neurovascular clinic (NVC) were randomised to usual care or to an intervention group who received a home visit at 1, 3 and 6 months from a clinical pharmacist. Pharmaceutical Care comprised medication review, medicines and lifestyle advice, pharmaceutical care issue (PCI) resolution and supply of individualised patient information. A pharmaceutical care plan was sent to the General Practitioner and CommunityPharmacy. Blood pressure and lipids were measured for both groups at baseline and at 6 months. Questionnaires covering satisfaction, quality of life and medicine adherence were administered at 6 months. ResultsOf 430 potentially eligible patients, 30 inpatients and 10 NVC outpatients were recruited. Only 33/364 (9.1%) NVC outpatients had new stroke. Thirty five patients completed the study (intervention = 18, usual care = 17).Questionnaire completion rates were 91.4% and 84.4% respectively. Blood pressure and lipid measurement processes were unreliable. From 104 identified PCIs, 19/23 (83%) recommendations made to General Practitioners were accepted. 3 ConclusionsModifications to recruitment is required to include patients with TIA. Questionnaire response rates met criteria but completion rates did not which merits fur...

Current perspectives on pharmacist home visits: do we keep reinventing the wheel?

“…The most commonly studied patient population was patients who had recently been discharged from hospital. 14 , 16 , 18 , 19 , 22 , 24 , 25 , 27 – 29 , 33 , 34 , 37 , 38 , 41 , 42 , 44 , 46 , 48 , 52 , 54 , 59 , 60 , 62 , 63 , 74 – 76 Heart failure was the most commonly mentioned diagnosis. 14 , 16 , 18 , 22 , 26 , 59 , 74 , 77 While HVs can be more convenient, not all patients may want or need a HV MR. 69 Furthermore, they may have preferences for how long it should take.…”

“…The nine RCTs and two cost-effectiveness analyses of pharmacist HV initiatives are outlined in Table 1 . 14 – 25 In general, the programs included those older than 60 years and who were expected to be at increased risk of medication misadventure. Five studied patients being discharged from hospital 14 , 16 , 18 , 19 , 22 and four recruited from outpatient settings.…”

“… 15 , 20 , 23 , 24 Souter et al recruited from both an inpatient and outpatient setting. 25 Additional eligibility criteria used to define the target study population included number of medications (≥2 to ≥5); functional decline, frailty, or disease-specific (CHF/stroke). Six of the studies described the qualifications of the pharmacists conducting the intervention, indicating training or experience beyond an entry to practice degree.…”

“…Also, the acceptance of recommendations made by the pharmacist was not always reported. Moreover, the extent of access the pharmacists had to medical and laboratory information was sometimes limited and may not have allowed for a comprehensive MR. 14 – 16 , 19 Maturation of clinical pharmacy services may have occurred over the course of years these studies were undertaken, and later studies appeared to involve pharmacists doing more detailed reviews with greater prescriber collaboration, 24 , 25 but did not evaluate economic outcomes. The most recent trial to evaluate economic outcomes was conducted by Barker et al; however, the usual care group received an extensive intervention which may have limited the impact of the study intervention.…”

“…Other activities performed by the pharmacists included removing expired or discontinued medications, 15 , 16 , 18 , 22 , 23 education, 14 – 16 , 18 , 22 , 24 , 25 and adherence assessment. 14 – 16 , 18 , 20 , 22 While these activities alone or together may be of benefit to patients, unless the medication regimen is optimized to ensure maximal efficacy and minimal harm, they might not be enough to significantly improve patient outcomes.…”