Pharmacist and manager of our Clinical Contact Centre, Suky Sandhu talks about the expanding role of her profession and the potential for positive patient interventions through support programmes like this one aimed at alcohol dependence.
It’s widely accepted that the role of pharmacists is changing. We’re moving away from just delivering the basics like medicine dispensing and into a place where we can add real value.
In my role at Celesio UK, I run a Clinical Contact Centre through which my team of expert pharmacists can provide interventions and guidance that is designed to improve medicine adherence over the phone. This is proving particularly effective in cases of alcohol dependence (alcohol misuse).
Alcohol dependence is a complex condition. It’s a combination of psychological and physiological issues which means the treatment requires special attention, and patients often benefit from one on one support.
The most common first line medication, recommended by NICE to treat Alcohol Dependence is Acamprosate. Studies have shown that many patients struggle to take the medication as prescribed which can lower adherence and increase the chances of a relapse.
That’s where we come in.
In the summer of 2016, we launched a clinical trial alongside Kings College London, which we refer to fondly as ADAM. It actually stands for Alcohol Dependency and Adherence to Medications.
ADAM is all about helping to prove which form of intervention works best to increase Acamprosate adherence. The trial is designed to guide future clinical practice by determining what approach is most effective.
So how does it work?
The participants of the trial have been randomly assigned to one of three groups: Standard Support (control group), Standard Support and Medication Management (SS+MM), and Standard Support, Medication Management and Contingency Management (SS+MM+CM).
The Standard Support involves receiving a monthly supply of the medication and regular follow-ups by the researchers at the end of months two, four, six and 12, but no intervention from our telephone support pharmacists.
Through the Medication Management service, we provide advice, information and support to patients to ensure they make the most of their medication. Through our Clinical Contact Centre we support patients to use Acamprosate correctly by providing education and practical advice over the phone which has the potential to increase the clinical effectiveness of the medication. This involves regular phone conversations with the selected participants over a period of six months. These calls are weekly for the first six weeks, followed by three fortnightly calls, before a final three monthly calls.
Contingency Management is based on the psychological theory of operant conditioning. The selected participants who receive CM are rewarded with small prizes and gifts when they display the desired behaviour, i.e. medicine adherence. This means that for every call completed with the telephone support pharmacist the participant achieves a £5 voucher with opportunities to accumulate bonuses for successive calls.
We’re currently a year into the three year trial period. So far, we have worked with over 200 patients and the results have been reassuringly significant.
This has been a really valuable opportunity to demonstrate how as community pharmacists, we can make a significant contribution to clinical trials. Through our community pharmacy network and our Clinical Contact Centre, we are ideally placed to deliver health interventions like this and help to deliver better patient outcomes.
My team and I are really proud to be involved in this work and we can see so many potential opportunities for our CCC to play a role in future research. Now, we’re all looking forward to seeing the final results from ADAM.