The MEDMAN study: a randomized controlled trial of community pharmacy-led medicines management for patients with coronary heart disease.
BACKGROUND
There have been recent moves to extend the role of the community pharmacist to include medicine management.


METHODS
A randomized controlled trial was conducted in nine sites in England. Patients with coronary heart disease were identified from general practice computer systems, recruited and randomized (2:1) to intervention or control. The 12-month intervention comprised an initial consultation with a community pharmacist to review appropriateness of therapy, compliance, lifestyle, social and support issues. Control patients received standard care. The primary outcome measures were appropriate treatment [derived from the National Service Framework (NSF)], health status (SF-36, EQ-5D) and an economic evaluation. Secondary outcome measures were patient risk of cardiovascular death and satisfaction.


RESULTS
The study involved 1493 patients (980 intervention and 513 control), 62 pharmacists and 164 GPs. No statistically significant differences between intervention and control groups were shown at follow-up for any of the primary outcome measures such as numbers on aspirin or lifestyle measures. There were few differences in quality of life (SF-36) between the intervention and control groups at baseline or follow-up or with overall EQ-5D score over time. The total National Health Service cost increased between baseline and at 12 months in both groups but to a greater extent in the intervention group. Significant improvements were found in the satisfaction score for patients' most recent pharmacy visit for prescription medicines among the intervention group, compared with control group. Self-reported compliance was good for both groups at baseline and no significant differences were shown at follow-up.


CONCLUSIONS
There was no change in the proportion of patients receiving appropriate medication as defined by the NSF. The pharmacist-led service was more expensive than standard care.
Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, UK.
D000368:Aged; D003157:Community Pharmacy Services; D003324:Coronary Artery Disease / Q000188:drug therapy*; D004739:England; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008509:Medication Systems / Q000458:organization & administration*; D008875:Middle Aged; D010595:Pharmacists; D024382:Professional Role; D011795:Surveys and Questionnaires