Minor ailment services from community pharmacy
- Publication Type:
- Thesis
- Issue Date:
- 2020
Open Access
Copyright Clearance Process
- Recently Added
- In Progress
- Open Access
This item is open access.
𝗕𝗮𝗰𝗸𝗴𝗿𝗼𝘂𝗻𝗱: Governments including the United Kingdom and Canada endeavour to optimise health care systems through investment in primary care reform. Community pharmacists are moving, encouraged by policy, to deliver self-care support in pharmacy. International studies indicate the role and scope of pharmacists in primary care could be expanded with clinical and economic savings.
𝗠𝗲𝘁𝗵𝗼𝗱𝘀: Chapter 1 presents a systematic review of randomized controlled trials evaluating self-management support interventions following the Cochrane handbook and PRISMA guidelines. Chapter 4 describes the qualitative research (a focus group with stakeholders, working meetings with general practitioners (GPs) to develop treatment pathways, and semi-structured interviews with community pharmacists) to co-design an Australian model minor ailment service (MAS) applicable to the Australian setting. Chapter 5 presents a protocol for a cluster-randomized controlled trial (cRCT) quantitatively evaluating the clinical, humanistic and economic effectiveness of MAS. MAS pharmacists were trained in treatment pathways pre-agreed with GPs and communication systems with GPs, and received monthly practice facilitator support. Control patients received usual pharmacist care (UC). Chapter 6 details the statistical analysis undertaken using modified Poisson regression. Chapter 7 details the cost utility analysis (CUA) conducted alongside the cRCT. Deterministic and probabilistic sensitivity analysis were performed.
𝗥𝗲𝘀𝘂𝗹𝘁𝘀: A theoretical model was developed providing structure to self-management in practice (Chapter 1). Chapter 4 presents the community pharmacy MAS model with the following elements: (1) In-pharmacy consultation, (2) treatment protocols on a technology platform (HealthPathways), (3) communication channels between pharmacy and GPs (HealthLink), (4) educational training, and (5) practice change support. Chapter 6 highlights findings from the cRCT. Patients (n=894) were recruited from 30 pharmacies and 82% (n=732) responded to follow up. Patients receiving MAS were 1.5 times more likely to receive an appropriate referral (relative rate (RR)=1.51; 95% confidence interval (CI)=1.07-2.11; p=0.018), and were 5 times more likely to adhere to referral, compared with UC patients (RR=5.08; 95%CI=2.02-12.79; p=0.001). MAS pharmacists were 2.6 times more likely to perform a clinical intervention (RR=2.62, 95%CI=1.28-5.38; p=0.009), compared with UC. MAS patients (94%) achieved symptom resolution or relief at follow up, while this was 88% with UC (RR=1.06; 95%CI=1-1.13; p=0.035). MAS patients had a greater mean difference in EQ-VAS at follow up (4.08; 95%CI=1.23-6.87; p=0.004). No difference in reconsultation was observed (RR=0.98; 95%CI=0.75-1.28; p=0.89). The CUA revealed MAS as cost-effective. MAS patients gained an additional 0.003 QALYs at an incremental cost of AUD $7.14, compared to UC. The resulting ICER was AUD $2,277/ QALY. The probabilistic SA revealed ICERs between AUD -$1,150 and $5,780/ QALY.
𝗖𝗼𝗻𝗰𝗹𝘂𝘀𝗶𝗼𝗻: Findings suggest MAS should be implemented within the Australian context. A series of recommendations are made including the development of self-care policy in Australia to provide a policy framework for MAS.
Please use this identifier to cite or link to this item: