title: Medication monitoring in a nurse-led respiratory outpatient clinic: pragmatic randomised trial of the West Wales Adverse Drug Reaction Profile.
abstract: OBJECTIVE
  To assess the clinical effect of medication monitoring using the West Wales Adverse Drug Reaction (ADR) Profile for Respiratory Medicine.
  
  
  METHODS
  Single-site parallel-arm pragmatic trial using stratified randomisation.
  
  
  METHODS
  Nurse-led respiratory outpatient clinic in general hospital in South Wales.
  
  
  METHODS
  54 patients with chronic respiratory disease receiving bronchodilators, corticosteroids or leukotriene receptor antagonists.
  
  
  METHODS
  Following initial observation of usual nursing care, we allocated participants at random to receive at follow up: either the West Wales ADR Profile for Respiratory Medicine in addition to usual care ('intervention arm' with 26 participants); or usual care alone ('control arm' with 28 participants).
  
  
  METHODS
  Problems reported and actions taken.
  
  
  RESULTS
  We followed up all randomised participants, and analysed data in accordance with treatment allocated. The increase in numbers of problems per participant identified at follow up was significantly higher in the intervention arm, where the median increase was 20.5 [inter-quartile range (IQR) 13-26], while that in the control arm was -1 [-3 to +2] [Mann-Whitney U test: z = 6.28, p<0.001]. The increase in numbers of actions per participant taken at follow up was also significantly higher in the intervention arm, where the median increase was 2.5 [1]-[4] while that in the control arm was 0 [-1.75 to +1] [Mann-Whitney U test: z = 4.40, p<0.001].
  
  
  CONCLUSIONS
  When added to usual nursing care, the West Wales ADR Profile identified more problems and prompted more nursing actions. Our ADR Profile warrants further investigation as a strategy to optimise medication management.
  
  
  BACKGROUND
  Controlled-trials.com ISRCTN10386209.
authors.affiliation: College of Human and Health Sciences, Swansea University, Swansea, United Kingdom.
authors.forename: Marie E
authors.initials: ME
authors.lastname: Gabe
authors.affiliation: College of Human and Health Sciences, Swansea University, Swansea, United Kingdom.
authors.forename: Fiona
authors.initials: F
authors.lastname: Murphy
authors.affiliation: ABM University Health Board, Wales, United Kingdom; College of Medicine, Swansea University, Swansea, United Kingdom.
authors.forename: Gwyneth A
authors.initials: GA
authors.lastname: Davies
authors.affiliation: West Wales Organisation for Rigorous Trials in Health, and College of Medicine, Swansea University, Swansea, United Kingdom.
authors.forename: Ian T
authors.initials: IT
authors.lastname: Russell
authors.affiliation: College of Human and Health Sciences, Swansea University, Swansea, United Kingdom.
authors.forename: Susan
authors.initials: S
authors.lastname: Jordan
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D016907:Adverse Drug Reaction Reporting Systems; D000368:Aged; D000554:Ambulatory Care Facilities; D001993:Bronchodilator Agents / Q000627:therapeutic use; D016903:Drug Monitoring; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020024:Leukotriene Antagonists / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009726:Nurses; D009729:Nursing / Q000379:methods*; D010045:Outpatients; D061214:Patient Safety; D012120:Respiration Disorders / Q000188:drug therapy* / Q000628:therapy*; D014852:Wales
chemical_list: D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents; D020024:Leukotriene Antagonists