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Effectiveness of visits from community pharmacists for patients with heart failure: HeartMed randomised controlled trial

BMJ, 2007-05, Vol.334 (7603), p.1098-1101 [Peer Reviewed Journal]

BMJ Publishing Group Ltd 2007 ;Copyright 2007 BMJ Publishing Group Ltd. ;2007 INIST-CNRS ;Copyright: 2007 (c) BMJ Publishing Group Ltd 2007 ;BMJ Publishing Group Ltd 2007 2007 BMJ Publishing Group Ltd ;ISSN: 0959-8138 ;ISSN: 0959-8146 ;EISSN: 1468-5833 ;EISSN: 1756-1833 ;DOI: 10.1136/bmj.39164.568183.AE ;PMID: 17452390 ;CODEN: BMJOAE

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Title:
Effectiveness of visits from community pharmacists for patients with heart failure: HeartMed randomised controlled trial
Author: Holland, Richard ; Brooksby, Iain ; Lenaghan, Elizabeth ; Ashton, Kate ; Hay, Laura ; Smith, Richard ; Shepstone, Lee ; Lipp, Alistair ; Daly, Clare ; Howe, Amanda ; Hall, Roger ; Harvey, Ian
Subjects: Biological and medical sciences ; Cardiology. Vascular system ; Clinical outcomes ; Clinical trials ; Communication ; Community Pharmacy Services - standards ; Confidence intervals ; Control groups ; Drug stores ; Experimentation ; General aspects ; Health outcomes ; Health participants ; Health services ; Heart ; Heart failure ; Heart Failure - drug therapy ; Heart Failure - mortality ; Heart failure, cardiogenic pulmonary edema, cardiac enlargement ; Home Care Services - standards ; Hospital admissions ; Hospitalization - statistics & numerical data ; Hospitals ; House Calls - statistics & numerical data ; Humans ; Intervention ; Medical sciences ; Mortality ; Nurses ; Patient admissions ; Patient Compliance ; Patients ; Pharmacists ; Prescription drugs ; Primary health care ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Quality of Life ; Questionnaires ; Smoking cessation ; Studies ; Treatment Outcome
Is Part Of: BMJ, 2007-05, Vol.334 (7603), p.1098-1101
Description: Objective To test whether a drug review and symptom self management and lifestyle advice intervention by community pharmacists could reduce hospital admissions or mortality in heart failure patients. Design Randomised controlled trial. Setting Home based intervention in heart failure patients. Participants 293 patients diagnosed with heart failure were included (149 intervention, 144 control) after an emergency admission. Intervention Two home visits by one of 17 community pharmacists within two and eight weeks of discharge. Pharmacists reviewed drugs and gave symptom self management and lifestyle advice. Controls received usual care. Main outcome measures The primary outcome was total hospital readmissions at six months. Secondary outcomes included mortality and quality of life (Minnesota living with heart failure questionnaire and EQ-5D). Results Primary outcome data were available for 291 participants (99%). 136 (91%) intervention patients received one or two visits. 134 admissions occurred in the intervention group compared with 112 in the control group (rate ratio=1.15, 95% confidence interval 0.89 to 1.48; P=0.28, Poisson model). 30 intervention patients died compared with 24 controls (hazard ratio=1.18, 0.69 to 2.03; P=0.54). Although EQ-5D scores favoured the intervention group, Minnesota living with heart failure questionnaire scores favoured controls; neither difference was statistically significant. Conclusion This community pharmacist intervention did not lead to reductions in hospital admissions in contrast to those found in trials of specialist nurse led interventions in heart failure. Given that heart failure accounts for 5% of hospital admissions, these results present a problem for policy makers who are faced with a shortage of specialist provision and have hoped that skilled community pharmacists could produce the same benefits. Trial registration number ISRCTN59427925.
Publisher: London: British Medical Journal Publishing Group
Language: English
Identifier: ISSN: 0959-8138
ISSN: 0959-8146
EISSN: 1468-5833
EISSN: 1756-1833
DOI: 10.1136/bmj.39164.568183.AE
PMID: 17452390
CODEN: BMJOAE
Source: MEDLINE
Alma/SFX Local Collection
ProQuest Central

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Effectiveness of visits from community pharmacists for patients with heart failure: HeartMed randomised controlled trial

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