Effectiveness and cost-effectiveness of a pragmatic clinical trial of the New Medicine Service intervention in Spanish community pharmacies

Abstract Background Non-adherence is associated with reduced quality of life, poorer outcomes, increased hospitalisations and deaths, and, consequently, higher healthcare costs. Community pharmacies are shown to be key elements in improving adherence to prescribed medications, optimizing patient outcomes and increasing care efficiency. Objective Examine whether the New Medicine Service intervention improved medication adherence among patients with new prescriptions for four diseases, compared with usual pharmacy care. Another aim was to estimate the cost-effectiveness of this intervention. Methods pragmatic cluster randomised clinical trial at community-pharmacy level in 23 community pharmacies (12 in control and 11 intervention arm) in Andalusia (Spain). Patients were invited to join the study who were identified as starting treatment for chronic obstructive pulmonary disease, hypertension or diabetes mellitus, or were on an anticoagulant/antiplatelet agent. The NMS intervention consisted of three steps: 1) establishing the commitment to the patient; 2) assessing adherence to the new medication and identifying problems with the medication and coming up with strategies to minimize such problems; 3) conducting follow-up visits to check adherence and evaluate intervention effects. Results At ten weeks and six months, outcomes showed slightly better medication adherence resulting from the intervention, however, this outcome was not statistically significant. At six months follow-up, reduced costs were exhibited in the intervention group relative to the control group, whilst the intervention group demonstrated greater utility. All of the above reveals the NMS intervention to be a dominant strategy when compared with typical treatment. Conclusion The NMS intervention that is based on communication between patients and pharmacists managed to achieve slight improvements in adherence to new prescriptions in patients with one of four pathologies. Cost-effectiveness analysis supports further use of the examined intervention, as it improves quality of life and reduces costs in comparison with typical practice ClinicalTrials.gov Identifier: NCT04195191 (Date: 2020-02-05).