title: The four or more medicines (FOMM) support service: results from an evaluation of a new community pharmacy service aimed at over-65s.
abstract: OBJECTIVE
  Inappropriate prescribing and nonadherence have a significant impact on hospital admissions and patient quality of life. The English government has identified that community pharmacy could make a significant contribution to reducing nonadherence and improving the quality of prescribing, reducing both hospital admissions and medicines wastage. The objective of this study is to evaluate a community pharmacy service aimed at patients over the age of 65 years prescribed four or more medicines.
  
  
  METHODS
  Patients were invited to participate in the service by the community pharmacy team. The pharmacist held regular consultations with the patient and discussed risk of falls, pain management, adherence and general health. They also reviewed the patient's medication using STOPP/START criteria. Data were analysed for the first 6 months of participation in the service.
  
  
  RESULTS
  Six hundred twenty patients were recruited with 441 (71.1%) completing the 6-month study period. Pharmacists made 142 recommendations to prescribers in 110 patients largely centred on potentially inappropriate prescribing of NSAIDs, PPIs or duplication of therapy. At follow-up, there was a significant decrease in the total number of falls (mean -0.116 (-0.217--0.014)) experienced and a significant increase in medicine adherence (mean difference in Morisky Measure of Adherence Scale-8: 0.513 (0.337-0.689)) and quality of life. Cost per quality-adjusted life year estimates ranged from £11 885 to £32 466 depending on the assumptions made.
  
  
  CONCLUSIONS
  By focussing on patients over the age of 65 years with four or more medicines, community pharmacists can improve medicine adherence and patient quality of life.
authors.affiliation: School of Pharmacy, Norwich, UK.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Twigg
authors.affiliation: School of Pharmacy, Norwich, UK.
authors.forename: David
authors.initials: D
authors.lastname: Wright
authors.affiliation: Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK.
authors.forename: Garry R
authors.initials: GR
authors.lastname: Barton
authors.affiliation: Contract Framework and Outcomes, Boots UK, Nottingham, UK.
authors.forename: Tracey
authors.initials: T
authors.lastname: Thornley
authors.affiliation: External Affairs, Celesio UK, Coventry, UK.
authors.forename: Clare
authors.initials: C
authors.lastname: Kerr
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D000368:Aged; D003157:Community Pharmacy Services / Q000458:organization & administration*; D004739:England; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D008297:Male; D055118:Medication Adherence; D010595:Pharmacists / Q000458:organization & administration*; D019338:Polypharmacy; D000067561:Potentially Inappropriate Medication List; D010818:Practice Patterns, Physicians' / Q000592:standards; D024382:Professional Role; D011788:Quality of Life; D019057:Quality-Adjusted Life Years
keywords: adherence; community pharmacy; falls; polypharmacy; quality of life
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