The opinion piece ‘Let’s be honest about the new medicine service’ (The Pharmaceutical Journal online, 21 August 2018) argues for more research before the new medicine service (NMS) is rolled out to mental health patients; the argument is based partly on statements about perceived weaknesses of our paper. Here, we clarify some inaccuracies in the representation of the research.
- The NMS was not rolled out after a proof-of-concept study; it differed in several significant ways from the original study, hence our randomised controlled trial (RCT) is the first effectiveness study of the service;
- The study was designed to test effects at 10 weeks, and we demonstrated effectiveness at that time. The 6-week data were for information, not decision-making. The 26-week data will be submitted to a journal in the next month;
- The “less-than-impressive sample size of 500 patients” was not intended to be impressive; it was based on a robust power calculation generated by a medical statistician based on assumptions agreed by external reviewers;
- The author refers to “atypical NMS-active pharmacies” being used in the study to recruit patients. It is not clear how the author makes the judgement “atypical”. The study was done in pharmacies offering NMS that were stratified by ownership, proximity to a GP surgery, setting and economic deprivation. The patient characteristics were comparable with those of the national PharmOutcomes database;
- One pharmacy recruited 99 patients to the study. As this was a patient-level RCT (patients were randomised within each pharmacy), any effect of this pharmacy is partially controlled through the randomisation process. However, we checked for a further bias. Removal of this subset of patients did not affect the effect size.
No research is perfect. We and others have already described and critiqued the actual weaknesses in our study[1]
,[2]
. We have addressed the issue of extrapolating to health from self-report by the use of modelling in our economic evaluation, which suggests the NMS is sufficiently cost effective to meet the National Institute for Health and Care Excellence’s criteria for adoption[3]
.
Rachel Elliott, professor of health economics, University of Manchester
Anthony Avery, professor of primary health care, University of Nottingham
Nick Barber, emeritus professor of pharmacy, UCL School of Pharmacy
Matthew Boyd, associate professor in pharmacy practice, University of Nottingham
References
[1] Elliott RA, Boyd MJ, Salema N-E et al. Supporting adherence for people starting a new medication for a long-term condition through community pharmacies: a pragmatic randomised controlled trial of the New Medicine Service. BMJ Qual Saf 2016;25:747–758. doi: 10.1136/bmjqs-2015-004400
[2] Bond CM. Adherence: the Holy Grail? BMJ Qual Saf 2016;25:736–738. doi: 10.1136/bmjqs-2015-004886
[3] Elliott RA, Tanajewski L, Gkountouras G et al. Cost-effectiveness of support for people starting a new medication for a long-term condition through community pharmacies: an economic evaluation of the New Medicine Service compared with normal practice. Pharmacoeconomics 2017;35:1237–1255. doi: 10.1007/s40273-017-0554-9
