Development and Feasibility Testing of a Supervised Pharmacy Student-Led Medication Review of Patients with Diabetes in Primary Care.
Introduction: The expected outcomes from medicines are, frequently not realised due to adverse reactions, inappropriate prescribing and patient failure to take their therapy as intended. Whilst medication review provided by pharmacists is designed to address these issues evidence for the effectiveness is weak, and sometimes counterintuitive. Reasons postulated are poor study design, inappropriate intervention location and limited consultations skills demonstrated by pharmacists. This thesis is designed to develop, feasibility test and pilot a supervised medication review service for patients with type 2 diabetes (T2DM) in primary care provided by undergraduate pharmacy students as part of their undergraduate education. Method: Literature review and focus groups were undertaken to refine the intervention. Ethical approval was obtained. Medication reviews were undertaken within the medical practices and supervised by a primary care based pharmacist. Students reviewed patient’s medicines and then one-to-one medication reviews with two patients. A range of outcome measures were utilised and tested. Recruitment and attrition rates were recorded. Patient and practitioner acceptability of the intervention and education experience was obtained. Results: 5 medical practices were recruited, from which 133 patients with T2DM consented to participate with 67 randomised to the intervention group. Thirty-two students undertook 58 medication reviews with patients. Patients reported satisfaction with student-led medication reviews and information received about medicines. No improvement in patient reported medication adherence or clinical outcomes were identified. The mean change in quality of life and patients’ satisfaction with information about medicines was significantly greater in the intervention group. Pharmacy students reported increased confidence and improved communication skills. Discussion and conclusions: The feasibility and pilot study provided data which would enable delivery of a future definitive trial. The intervention was deemed acceptable by patients and demonstrated improved quality of life and satisfaction with information about medicines. Educational benefits of this study were also observed.
Networked Digital Library of Theses and Dissertations