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Randomized Controlled Trial
. 2023 Oct 2;219(7):325-331.
doi: 10.5694/mja2.52073. Epub 2023 Aug 16.

Activating pharmacists to reduce the frequency of medication-related problems (ACTMed): a stepped wedge cluster randomised trial

Jean Spinks  1 , Richard Violette  1   2 , Douglas Ir Boyle  3 , Dennis Petrie  4 , Laura Fanning  4   5 , Kerry K Hall  2 , Fiona Kelly  2 , Amanda J Wheeler  6   7 , Robert S Ware  6 , Joshua Byrnes  8 , Esa Chen  4 , Andrew Donald  9 , Nicolette Ellis  10 , Megan DelDot  1 , Lisa Nissen  1
Affiliations
Randomized Controlled Trial

Activating pharmacists to reduce the frequency of medication-related problems (ACTMed): a stepped wedge cluster randomised trial

Jean Spinks et al. Med J Aust. .

Abstract

Background: Medicines are the most frequent health care intervention type; their safe use provides significant benefits, but inappropriate use can cause harm. Systemic primary care approaches can manage serious medication-related problems in a timely manner.

Objectives: ACTMed (ACTivating primary care for MEDicine safety) uses information technology and financial incentives to encourage pharmacists to work more closely with general practitioners to reduce the risk of harm, improve patients' experience of care, streamline workflows, and increase the efficiency of medical care.

Methods and analysis: The stepped wedge cluster randomised trial in 42 Queensland primary care practices will assess the effectiveness of the ACTMed intervention. The primary outcome will be the proportion of people at risk of serious medication-related problems - patients with atrial fibrillation, heart failure, cardiovascular disease, type 2 diabetes, or asthma or chronic obstructive pulmonary disease - who experience such problems. We will also estimate the cost per averted serious medication-related problem and the cost per averted potentially preventable medication-related hospitalisation.

Ethics approval: The University of Queensland Human Research Ethics Committee approved the pilot (2021/HE002189) and trial phases of the ACTMed study (2022/HE002136). Access to Patron data was granted by the Patron Data Governance Committee (PAT052ACTMed). Access to linked hospitalisations and deaths data are subject to Public Health Act approval (pending).

Dissemination of findings: A comprehensive dissemination plan will be co-developed by the researchers, the ACTMed steering committee and consumer advisory group, project partners, and trial site representatives. Aboriginal and Torres Strait Islander communities will be supported in leading community-level dissemination.

Trial registration: Australian New Zealand Clinical Trials Registry (pilot: ACTRN12622000595718; 21 April 2022; full trial: ACTRN12622000574741; 14 April 2022).

Keywords: General practice; Patient safety; Pharmacist; Primary care; Quality assurance, health care.

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References

    1. Australian Commission on Safety and Quality in Health Care. National safety and quality health service standards. Sept 2012. www.safetyandquality.gov.au/sites/default/files/migrated/NSQHS-Standards... (viewed Mar 2022).
    1. Roughead EE, Semple SJ. Medication safety in acute care in Australia: where are we now? Part 1: a review of the extent and causes of medication problems 2002-2008. Aust New Zealand Health Policy 2009; 6: 18.
    1. Roughhead L, Semple S, Rosenfeld E. Literature review: medication safety in Australia. Australian Commission on Safety and Quality in Health Care; Aug 2013. www.safetyandquality.gov.au/sites/default/files/migrated/Literature-Revi... (viewed Mar 2022).
    1. Spinks J, Birch S, Wheeler AJ, et al. Provision of home medicines reviews in Australia: linking population need with service provision and available pharmacist workforce. Aust Health Rev 2020; 44: 973-982.
    1. Donaldson LJ, Kelley ET, Dhingra-Kumar N, et al. Medication without harm: WHO's third global patient safety challenge. Lancet 2017; 389: 1680-1681.

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