Effectiveness of shared pharmaceutical care for older patients: RESPECT trial findings

Abstract

Background: The pharmaceutical care approach serves as a model for medication review, involving collaboration between GPs, pharmacists, patients, and carers. Its use is advocated with older patients who are typically prescribed several drugs. However, it has yet to be thoroughly evaluated.

Aim: To estimate the effectiveness of pharmaceutical care for older people, shared between GPs and community pharmacists in the UK, relative to usual care.

Design of study: Multiple interrupted time-series design in five primary care trusts which implemented pharmaceutical care at 2-month intervals in random order. Patients acted as their own controls, and were followed over 3 years including their 12 months' participation in pharmaceutical care.

Setting: In 2002, 760 patients, aged > or =75 years, were recruited from 24 general practices in East and North Yorkshire. Sixty-two community pharmacies also took part. A total of 551 participants completed the study.

Method: Pharmaceutical care was undertaken by community pharmacists who interviewed patients, developed and implemented pharmaceutical care plans together with patients' GPs, and thereafter undertook monthly medication reviews. Pharmacists and GPs attended training before the intervention. Outcome measures were the UK Medication Appropriateness Index, the Short Form-36 Health Survey (SF-36), and serious adverse events.

Results: The intervention did not lead to any statistically significant change in the appropriateness of prescribing or health outcomes. Although the mental component of the SF-36 decreased as study participants become older, this trend was not affected by pharmaceutical care.

Conclusion: The RESPECT model of pharmaceutical care (Randomised Evaluation of Shared Prescribing for Elderly people in the Community over Time) shared between community pharmacists and GPs did not significantly change the appropriateness of prescribing or quality of life in older patients.

Figure 1

Progress of participants through the RESPECT trial. PCT = primary care trust.

Figure 2

Top: mean UK Medication Appropriateness Index (UK-MAI) scores per scored drug over five time points. Refer to Appendix 3 for actual mean values. Bottom: key illustrating the changes expected according to the model used to analyse these data.

Figure 3

Mean Short Form–36 Health Survey (SF-36) physical component scores (PCS: top) and mental component scores (MCS: bottom) over five time points.