A cluster randomised control trial to evaluate the effectiveness and cost-effectiveness of the Italian medicines use review (I-MUR) for asthma patients

Background The economic burden of asthma, which relates to the degree of control, is €5 billion annually in Italy. Pharmacists could help improve asthma control, reducing this burden. This study aimed to evaluate the effectiveness and cost-effectiveness of Medicines Use Reviews provided by community pharmacists in asthma. Methods This cluster randomised, multi-centre, controlled trial in adult patients with asthma was conducted in 15 of the 20 regions of Italy between September 2014 and July 2015. After stratification by region, community pharmacists were randomly allocated to group A (trained in and delivered the intervention at baseline) or B (training and delivery 3 months later), using computerised random number generation in blocks of 10. Each recruited up to five patients, with both groups followed for 9 months. The intervention consisted of a systematic, structured face-to-face consultation with a pharmacist, covering asthma symptoms, medicines used, attitude towards medicines and adherence, recording pharmacist-identified pharmaceutical care issues (PCIs). The primary outcome was asthma control, assessed using the Asthma-Control-Test (ACT) score (ACT ≥ 20 represents good control). Secondary outcomes were: number of active ingredients, adherence, cost-effectiveness compared with usual care. Although blinding was not possible for either pharmacists or patients, assessment of outcomes was conducted by researchers blind to group allocation. Results Numbers of pharmacists and patients enrolled were 283 (A = 136; B = 147) and 1263 (A = 600; B = 663), numbers completing were 201 (A = 97; B = 104) and 816 (A = 400; B = 416), respectively. Patients were similar in age and gender and 56.13% (458/816) had poor/partial asthma control. Pharmacists identified 1256 PCIs (mean 1.54/patient), mostly need for education, monitoring and potentially ineffective therapy. Median ACT score at baseline differed between groups (A = 19, B = 18; p < 0.01). Odds ratio for improved asthma control was 1.76 (95% CI 1.33–2.33) and number needed to treat 10 (95% CI 6–28). Number of active ingredients reduced by 7.9% post-intervention (p < 0.01). Adherence improved by 35.4% 3 months post-intervention and 40.0% at 6 months (p < 0.01). The probability of the intervention being more cost-effective than usual care was 100% at 9 months. Conclusions This community pharmacist-based intervention demonstrated both effectiveness and cost-effectiveness. It has since been implemented as the first community pharmacy cognitive service in Italy

A network analysis of adolescent mental well-being during the coronavirus pandemic: Evidence for cross-cultural differences in central features

The COVID-19 pandemic continues to pose unprecedented threat globally. Adolescents and youth may be especially susceptible to the long-term impact of these stressors, thus intervening early is an important priority. However, it is also crucial to understand how young people maintain psychological well-being in the face of adversity, particularly given that many nations are experiencing further waves of the pandemic. The understanding of such resilient outcomes could inform the development of programs to encourage positive mental health.We explored adolescents' resilience to the COVID-19 pandemic stress by examining core aspects of well-being across countries using network analysis. Using the short Warwick–Edinburgh Mental Wellbeing Scale, cross-sectional data was collected online from adolescents from India (N = 310; Males = 159, Females = 151, aged 12–18 years), Israel (N = 306; Males = 154, Females = 152, aged 12–18 years) and the United Kingdom (UK; N = 1666; Males = 598, Females = 1068, aged 12–25 years). Two highly similar network clusters were identified for UK and Israel, with three clusters emerging for India. UK and Israeli networks centred on “dealing with problems well” while the Indian network centred on “feeling useful”. As central items highlight aspects of well-being that influence or are influenced by other aspects, these findings may inform interventions to safeguard adolescent mental health during future phases of the pandemic