Evidence map›Paper›PMID 25833666›Full record

Trial reportBMJ open2015

Pharmacist-led management of chronic pain in primary care: costs and benefits in a pilot randomised controlled trial.

Aileen R Neilson, Hanne Bruhn, Christine M Bond, Alison M Elliott, Blair H Smith, Philip C Hannaford, Richard Holland, Amanda J Lee, Margaret Watson, David Wright and 1 more

Open access · goldAbstract readComparative StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMJ open, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
19citing papers in PubMed, 6 pooled it
1.8field-weighted citation impact, top 15% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

19 citing papers in PubMed, 6 syntheses or guidelines pooled it, 36 citations in OpenAlex.

  1. Pooled it
  2. Impact of integrating pharmacists into primary care teams on health systems indicators: a systematic review.The British journal of general practice : the journal of the Royal College of General Practitioners · 2019
    Pooled it
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  4. General medical services by non-medical health professionals: a systematic quantitative review of economic evaluations in primary care.The British journal of general practice : the journal of the Royal College of General Practitioners · 2019
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  7. Review
  8. Adoption of clinical pharmacist roles in primary care: longitudinal evidence from English general practice.The British journal of general practice : the journal of the Royal College of General Practitioners · 2025
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  17. Observational
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 3 institutions in 1 country.

Aileen R NeilsonHealth Economics Research Unit, University of Aberdeen, Aberdeen, UK.
Hanne BruhnCentre of Academic Primary Care, University of Aberdeen, Aberdeen, UK.
Christine M BondCentre of Academic Primary Care, University of Aberdeen, Aberdeen, UK.
Alison M ElliottCentre of Academic Primary Care, University of Aberdeen, Aberdeen, UK.
Blair H SmithDivision of Population Sciences, University of Dundee, Dundee, UK.
Philip C HannafordCentre of Academic Primary Care, University of Aberdeen, Aberdeen, UK.
Richard HollandNorwich Medical School, University of East Anglia, Norwich, UK.
Amanda J LeeMedical Statistics Team, University of Aberdeen, Aberdeen, UK.
Margaret WatsonCentre of Academic Primary Care, University of Aberdeen, Aberdeen, UK.
David WrightSchool of Pharmacy, University of East Anglia, Norwich, UK.
Paul McNameeHealth Economics Research Unit, University of Aberdeen, Aberdeen, UK.
University of Aberdeen · GBUniversity of East Anglia · GBUniversity of Dundee · GB

Funding

Chief Scientist Office HERU1Chief Scientist Office HSRU2Medical Research Council G0701769
6 · The paper itself

Abstract

objectivesTo explore differences in mean costs (from a UK National Health Service perspective) and effects of pharmacist-led management of chronic pain in primary care evaluated in a pilot randomised controlled trial (RCT), and to estimate optimal sample size for a definitive RCT.

designRegression analysis of costs and effects, using intention-to-treat and expected value of sample information analysis (EVSI).

settingSix general practices: Grampian (3); East Anglia (3).

participants125 patients with complete resource use and short form-six-dimension questionnaire (SF-6D) data at baseline, 3 months and 6 months.

interventionsPatients were randomised to either pharmacist medication review with face-to-face pharmacist prescribing or pharmacist medication review with feedback to general practitioner or treatment as usual (TAU).

main outcome measuresDifferences in mean total costs and effects measured as quality-adjusted life years (QALYs) at 6 months and EVSI for sample size calculation.

resultsUnadjusted total mean costs per patient were £452 for prescribing (SD: £466), £570 for review (SD: £527) and £668 for TAU (SD: £1333). After controlling for baseline costs, the adjusted mean cost differences per patient relative to TAU were £77 for prescribing (95% CI -82 to 237) and £54 for review (95% CI -103 to 212). Unadjusted mean QALYs were 0.3213 for prescribing (SD: 0.0659), 0.3161 for review (SD: 0.0684) and 0.3079 for TAU (SD: 0.0606). Relative to TAU, the adjusted mean differences were 0.0069 for prescribing (95% CI -0.0091 to 0.0229) and 0.0097 for review (95% CI -0.0054 to 0.0248). The EVSI suggested the optimal future trial size was between 460 and 690, and between 540 and 780 patients per arm using a threshold of £30,000 and £20,000 per QALY gained, respectively.

conclusionsCompared with TAU, pharmacist-led interventions for chronic pain appear more costly and provide similar QALYs. However, these estimates are imprecise due to the small size of the pilot trial. The EVSI indicates that a larger trial is necessary to obtain more precise estimates of differences in mean effects and costs between treatment groups. TRIAL REGISTRATION NUMBER: ISRCTN06131530.

Indexed as

Chronic PainCost-Benefit AnalysisPharmacistsProfessional RoleQuality-Adjusted Life YearsAnalgesicsDrug PrescriptionsFemaleGeneral PracticeHealth Care CostsHumansIntention to Treat AnalysisMalePain ManagementPharmacyPrimary Health CareAnalgesicsHEALTH ECONOMICSPAIN MANAGEMENTPRIMARY CARE

Identifiers

PMID25833666
PMCPMC4390732
OpenAlexW2142201121

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.