The Long Term Conditions service: An examination of the impact of the service on patients’ health outcomes and an exploration of pharmacists’ views and experiences with the service

Abstract

Background: International evidence has highlighted the positive contribution community pharmacist-led interventions can have on improving patients’ medication adherence and health outcomes. Little evidence to date has been published examining the impact of a New Zealand pharmacist-led service called the Long Term Conditions (LTC) service. Aims: The present research examined the impact of the LTC service on patients’ medication adherence and ambulatory sensitive hospitalisations (ASH). It also sought to understand how community pharmacists provide the LTC service, and to explore community pharmacists’ views and experiences with the service and its provision. Methods: A sequential, explanatory, mixed-method design was employed comprising: 1) a systematic review; 2) a retrospective matched-cohort study (n=102,276) using routinely collected health data; 3) semi-structured interviews with community pharmacists (n=18); 4) observation of community pharmacy sites (n=6). Results: Enrolment in LTC contributed to improved medication adherence, with patients in the intervention group having 2.99 (95% CI:2.79-3.20) greater odds of being adherent compared to the control group (12 months after start of the intervention). Unexpectedly, enrolment in LTC contributed to greater ASH, with patients in the intervention group having 1.86 (95% CI:1.78-1.96) greater odds of having an ASH compared to the control group (12 months after the start of the intervention). The present research identified factors that influence LTC service provision, primarily: tensions in the pharmacy, which stem from financial pressures; pharmacists working in isolation; and pharmacists having multiple competing and concurrent roles. Other factors included LTC disrupting pharmacies’ ‘business-as-usual’, as LTC is a time intensive service which ideally requires the integration of the service into pharmacy workflow. For some pharmacists LTC has positively changed the focus of their work, however for the majority of those interviewed, LTC has not. Pharmacists disclosed they feel there is a lack of value of pharmacy and LTC, and this is reflected in a lack of buy-in to the service by various stakeholders. Conclusion: The LTC service achieved one of its primary goals of improved medication adherence. However, this was decoupled from improvements in clinical outcomes, as this research found greater ASH amongst LTC enrolled patients. Possible reasons for the greater hospitalisations were proposed, however further research is needed. A range of factors were identified that influence pharmacists’ LTC service provision. These factors should be considered when introducing new pharmacy services.