Evidence map›Paper›PMID 36787910›Full record

Trial reportBMJ (Clinical research ed.)2023

Evaluation of effectiveness and safety of pharmacist independent prescribers in care homes: cluster randomised controlled trial.

Richard Holland, Christine Bond, David P Alldred, Antony Arthur, Garry Barton, Linda Birt, Jeanette Blacklock, Annie Blyth, Stamatina Cheilari, Amrit Daffu-O'Reilly and 18 more

Erratum issuedOpen access · hybridAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMJ (Clinical research ed.), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 21 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
21citing papers in PubMed, 8 pooled it
3.9field-weighted citation impact, top 6% 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

21 citing papers in PubMed, 8 syntheses or guidelines pooled it, 22 citations in OpenAlex.

  1. Pooled it
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  4. Interventions for preventing falls in older people in care facilities.The Cochrane database of systematic reviews · 2025
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

28 authors at 6 institutions in 1 country.

Richard HollandLeicester Medical School, University of Leicester, Leicester, UK.
Christine BondInstitute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
David P AlldredSchool of Healthcare, University of Leeds, Leeds, UK.
Antony ArthurSchool of Health Sciences, University of East Anglia, Norwich, UK.
Garry BartonNorwich Medical School, University of East Anglia, Norwich, UK.
Linda BirtSchool of Health Sciences, University of East Anglia, Norwich, UK.
Jeanette BlacklockSchool of Pharmacy, University of East Anglia, Norwich, UK.
Annie BlythNorwich Medical School, University of East Anglia, Norwich, UK.
Stamatina CheilariNorwich Medical School, University of East Anglia, Norwich, UK.
Amrit Daffu-O'ReillySchool of Healthcare, University of Leeds, Leeds, UK.
Lindsay DalgarnoInstitute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
James DesboroughSchool of Pharmacy, University of East Anglia, Norwich, UK.
Joanna FordGeriatric Medicine, Addenbrooke's Hospital, Cambridge, UK.
Kelly GrantNorwich Clinical Trials Unit, University of East Anglia, Norwich, UK.
Bronwen HarryNorwich Clinical Trials Unit, University of East Anglia, Norwich, UK.
Helen HillStow Healthcare Ltd, Bury St. Edmunds, UK.
Carmel HughesSchool of Pharmacy, Queen's University Belfast, Belfast, UK.
Jacqueline InchInstitute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
Vivienne MaskreyNorwich Medical School, University of East Anglia, Norwich, UK.
Phyo MyintInstitute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
Nigel NorrisSchool of Education and Lifelong Learning, University of East Anglia, Norwich, UK.
Fiona PolandSchool of Health Sciences, University of East Anglia, Norwich, UK.
Lee ShepstoneNorwich Medical School, University of East Anglia, Norwich, UK.
Maureen SpargoSchool of Pharmacy, Queen's University Belfast, Belfast, UK.
David TurnerNorwich Medical School, University of East Anglia, Norwich, UK.
Laura WattsNorwich Medical School, University of East Anglia, Norwich, UK.
Arnold ZermanskySchool of Healthcare, University of Leeds, Leeds, UK.
David WrightSchool of Healthcare, University of Leicester, Leicester, UK d.j.wright@leicester.ac.uk.ORCID 0000-0003-3690-9593
University of East Anglia · GBUniversity of Aberdeen · GBUniversity of Leeds · GBQueen's University Belfast · GBUniversity of Leicester · GBAddenbrooke's Hospital · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo estimate the effectiveness, cost effectiveness (to be reported elsewhere), and safety of pharmacy independent prescribers in care homes.

designCluster randomised controlled trial, with clusters based on triads of a pharmacist independent prescriber, a general practice, and one to three associated care homes.

settingCare homes across England, Scotland, and Northern Ireland, their associated general practices, and pharmacy independent prescribers, formed into triads.

participants49 triads and 882 residents were randomised. Participants were care home residents, aged ≥65 years, taking at least one prescribed drug, recruited to 20 residents/triad.

interventionEach pharmacy independent prescriber provided pharmaceutical care to approximately 20 residents across one to three care homes, with weekly visits over six months. Pharmacy independent prescribers developed a pharmaceutical care plan for each resident, did medicines reviews/reconciliation, trained staff, and supported with medicines related procedures, deprescribing, and authorisation of prescriptions. Participants in the control group received usual care. MAIN OUTCOMES MEASURES: The primary outcome was fall rate/person at six months analysed by intention to treat, adjusted for prognostic variables. Secondary outcomes included quality of life (EQ-5D by proxy), Barthel score, Drug Burden Index, hospital admissions, and mortality. Assuming a 21% reduction in falls, 880 residents were needed, allowing for 20% attrition.

resultsThe average age of participants at study entry was 85 years; 70% were female. 697 falls (1.55 per resident) were recorded in the intervention group and 538 falls (1.26 per resident) in the control group at six months. The fall rate risk ratio for the intervention group compared with the control group was not significant (0.91, 95% confidence interval 0.66 to 1.26) after adjustment for all model covariates. Secondary outcomes were not significantly different between groups, with exception of the Drug Burden Index, which significantly favoured the intervention. A third (185/566; 32.7%) of pharmacy independent prescriber interventions involved medicines associated with falls. No adverse events or safety concerns were identified.

conclusionsChange in the primary outcome of falls was not significant. Limiting follow-up to six months combined with a small proportion of interventions predicted to affect falls may explain this. A significant reduction in the Drug Burden Index was realised and would be predicted to yield future clinical benefits for patients. This large trial of an intensive weekly pharmacist intervention with care home residents was also found to be safe and well received.

trial registrationISRCTN 17847169.

Indexed as

Pharmaceutical ServicesPharmacistsAged, 80 and overFemaleHumansMaleNorthern IrelandQuality of LifeScotland

Identifiers

PMID36787910
PMCPMC9926330
OpenAlexW4320724530

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.