Effectiveness of a medication adherence management intervention in a community pharmacy setting: a cluster randomised controlled trial

BackgroundNon-adherence to medications continues to be a burden worldwide, with significant negative consequences. Community pharmacist interventions seem to be effective at improving medication adherence. However, more evidence is needed regarding their impact on disease-specific outcomes. The aim was to evaluate the impact of a community pharmacist-led adherence management intervention on adherence and clinical outcomes in patients with hypertension, asthma and chronic obstructive pulmonary disease (COPD).MethodsA 6-month cluster randomised controlled trial was conducted in Spanish community pharmacies. Patients suffering from hypertension, asthma and COPD were recruited. Patients in the intervention group received a medication adherence management intervention and the control group received usual care. The intervention was based on theoretical frameworks for changing patient behaviour. Medication adherence, disease-specific outcomes (Asthma Control Questionnaire (ACQ) scores, Clinical COPD Questionnaire (CCQ) scores and blood pressure levels) and disease control were evaluated. A multilevel regression model was used to analyse the data.ResultsNinety-eight pharmacies and 1186 patients were recruited, with 1038 patients completing the study. Patients receiving the intervention had an OR of 5.12 (95% CI 3.20 to 8.20, pConclusionsA community pharmacist-led medication adherence intervention was effective at improving medication adherence and clinical outcomes in patients suffering from hypertension, asthma and COPD. Future research should explore the implementation of these interventions in routine practice.Trial registration numberACTRN12618000410257

Cost-Utility Analysis of a Medication Adherence Management Service Alongside a Cluster Randomized Control Trial in Community Pharmacy.

Background: It is necessary to determine the cost utility of adherence interventions in chronic diseases due to humanistic and economic burden of non-adherence. Purpose: To evaluate, alongside a cluster-randomized controlled trial, the cost-utility of a pharmacist-led medication adherence management service (MAMS) compared with usual care in community pharmacies. Materials and Methods: The trial was conducted over six months. Patients with treatments for hypertension, asthma or chronic obstructive pulmonary disease (COPD) were included. Patients in the intervention group (IG) received a MAMS based on a brief complex intervention, whilst patients in the control group (CG) received usual care. The cost–utility analysis adopted a health system perspective. Costs related to medications, healthcare resources and adherence intervention were included. The effectiveness was estimated as quality-adjusted life years (QALYs), using a multiple imputation missing data model. The incremental cost–utility ratio (ICUR) was calculated on the total sample of patients. Results: A total of 1186 patients were enrolled (IG: 633; CG: 553). The total intervention cost was estimated to be € 27.33 ± 0.43 per patient for six months. There was no statistically significant difference in total cost of medications and healthcare resources per patient between IG and CG. The values of EQ-5D-5L at 6 months were significantly higher in the IG [IG: 0.881 ± 0.005 vs CG: 0.833 ± 0.006; p = 0.000]. In the base case, the service was more expensive and more effective than usual care, resulting in an ICUR of € 1,494.82/QALY. In the complete case, the service resulted in an ICUR of € 2,086.30/QALY, positioned between the north-east and south-east quadrants of the cost–utility plane. Using a threshold value of € 20,000/QALY gained, there is a 99% probability that the intervention is cost-effective. Conclusion: The medication adherence management service resulted in an improvement in the quality of life of the population with chronic disease, with similar costs compared to usual care. The service is cost-effective

Neutron capture measurement at the n TOF facility of the 204Tl and 205Tl s-process branching points

Neutron capture cross sections are one of the fundamental nuclear data in the study of the s (slow) process of nucleosynthesis. More interestingly, the competition between the capture and the decay rates in some unstable nuclei determines the local isotopic abundance pattern. Since decay rates are often sensible to temperature and electron density, the study of the nuclear properties of these nuclei can provide valuable constraints to the physical magnitudes of the nucleosynthesis stellar environment. Here we report on the capture cross section measurement of two thallium isotopes, 204Tl and 205Tl performed by the time-of-flight technique at the n TOF facility at CERN. At some particular stellar s-process environments, the decay of both nuclei is strongly enhanced, and determines decisively the abundance of two s-only isotopes of lead, 204Pb and 205Pb. The latter, as a long-lived radioactive nucleus, has potential use as a chronometer of the last s-process events that contributed to final solar isotopic abundances

Determinación de ácidos grasos en leche bubalina (Bubalus bubalis) producida en Corrientes, Argentina

El objetivo del estudio fue determinar los valores de ácidos grasos saturados e insaturados, especialmente ácido linoleico conjugado (CLA) y ácidos omega 3 y 6, en leche de búfalas de la Provincia de Corrientes. Se emplearon 16 búfalas multíparas de raza Murrah y mestizas Murrah x Mediterránea, distribuidas en 2 grupos integrados por 8 animales cada uno (4 Murrah y 4 mestizas). El primero fue alimentado con pasturales naturales ad libitum y el segundo con pasturas naturales y un suplemento diario de 2 kg de maíz molido por animal. El ensayo duró 35 días. En los días 1 y 35 se obtuvieron muestras de leche de todas las búfalas (32 muestras). Para la dieta de pastura natural con y sin suplementación, los ácidos grasos saturados fueron de 56,91 y 57,10%, en tanto que los insaturados fueron de 43,68 y 42,89% respectivamente. De estos últimos, el 37,24 y 36,92% correspondieron a monoinsaturados y el 5,84 y 5,97% a polinsaturados respectivamente. Entre los ácidos grasos saturados predominó el C16:0 y entre los insaturados el C18:1. El ácido C14:0 reveló diferencias significativas según época de muestreo y dieta (p<0,05), resultando mayor al día 35 y en animales suplementados. El nivel de CLA en búfalas no suplementadas fue de 10,29 mg/g de grasa láctea. Existió una correlación positiva entre CLA y acido vaccénico en la grasa láctea (r = 0.87). La relación de ácidos grasos omega 6 y omega 3 fue de 2,07/1 al final del ensayo. En conclusión, se establecen valores de referencia para ácidos grasos en leche bubalina y se espera que estos datos asuman importancia al momento de compararlos con los obtenidos mediante otras estrategias dietarias, con el propósito de incrementar el contenido de CLA y omega 3 en la leche de búfalas