Innovation update: ‘Patients want this service’

Dr. Debbie Kelly

Patients with complex medication regimens greatly appreciate—and benefit from—comprehensive medication assessments, confirms a study conducted by Dr. Debbie Kelly, Professor of Pharmacy, and her research team at Memorial University of Newfoundland.

Moreover, patients voluntarily reported high levels of satisfaction in areas outside the study’s original scope, such as pharmacists’ efforts to improve the affordability of medications.

The study, funded by the Canadian Foundation for Pharmacy’s Innovation Fund, ocurred occurred at the Medication Therapy Services (MTS) Clinic, a learning clinic for the University’s entry-to-practice PharmD program. Pharmacists and pharmacy students conduct holistic, comprehensive medication assessments (CMAs) to improve patients’ quality of life, for example by reducing the complexity of taking multiple medications.

About half of the clinic’s patients are referred by family physicians, nurse practitioners and specialists. “We’re finding the complexity of patients being referred is increasing,” says Kelly. “Specialists see the value in working with us.”

The MTS study sought to assess the impact of the CMA interventions by using the Medication-Related Burden Quality of Life (MRB-QoL) tool, a statistically validated survey tool that measures QoL across five domains (routine and regime complexity, psychological burden, functional limitation, therapeutic relationship and social burden). Participating patients had a median age of 71.7 years, were taking an average of 12.9 medications and lived with a minimum of two chronic conditions; 197 were involved in the final data analysis.

From February 2021 to May 2023, pharmacists and students gathered patients’ responses to the survey tool during the initial CMA and follow-up appointments at six weeks and 12 weeks. Pharmacists made an average of 3.9 recommendations to improve medication therapy per participant. Recommendations to deprescribe a medication occurred for 64% of patients.

Significant improvements in quality of life were recorded in the domains of complexity (i.e., simplifying regimens), psychological burden (e.g., allaying concerns about medications) and functionality (e.g., management of side effects). Ninety eight percent of patients agreed or strongly agreed they were totally satisfied with their visits and 72% understood their medications better.

“Patients want this service and desire the ability to have a longer appointment with healthcare providers than what is currently available,” states the study’s final report, which also notes that the CMA services at the MTS Clinic are provided by salaried pharmacists employed by the University. Within community practice, “scaling and sustaining of this model will require an appropriate remuneration model which recognizes the impact of CMA on improving patient outcomes.”

Kelly adds: “These results are applicable to community pharmacy practice as it moves towards more of a clinic model or chronic-disease-management type of model.”

That said, all community pharmacists can take away the fact that medication management services, such as addressing patients’ concerns about side effects and simplifying regimens, have a direct positive impact on quality of life, notes Kelly.

Additional benefits

As the study progressed, Kelly and her team noticed that patients were reporting benefits that could not be captured with the MRB survey tool. They decided to additionally interview some of the participants to ask them to describe in their own words what they found beneficial.

Financial worries frequently came up. “They said, ‘I’m having trouble paying for my medications and I was really hoping we could find some cheaper alternatives,’” notes Kelly.

Another big area ties into concerns that people had about whether their medications were still necessary or even working, especially if they had been taking them for a long time. After the CMA, “they reported feeling really reassured that the pharmacist could explain that, yes, they actually do need three blood-pressure medications, for example, and they’re happy to continue taking them now that they understand that.”