Polypharmacy phone counselling can save lives

Periodic telephone counselling of patients receiving multiple drugs for chronic diseases can improve compliance with the medication regime – and save lives, according research published in the British Medical Journal.

The researchers, from the Chinese University of Hong Kong, say that further work needs to be carried out and they are currently doing another study with patients with chronic heart failure.

The research was conducted in Hong Kong with 502 non-compliant patients receiving polypharmacy which was defined as taking five or more drugs for chronic diseases.

Sixty patients dropped out of the trial and the remaining 442 were divided randomly between a group receiving the telephone counselling intervention and a control group. After two years 52% of the defaulters had died along with 17% of the control group. But only 11% of the intervention group died.

The researchers found that, after adjusting for confounding variables, telephone counselling was associated with a 41% reduction in the risk of death. Other predictors of outcome identified included old age, living alone, rate of admission to hospital, compliance score, number of drugs being taken for chronic disease and non-treatment with lipid lowering drugs at initial screening.

Hong Kong has a heavily subsided health system where, the researchers say, patients pay only nominal sums for clinic visits that include the cost of drugs. Chronic diseases are monitored by hospital teams at appointments every two to four months for clinically stable patients.

The intervention group received a 10-15 minutes call from the team pharmacist at the midpoint between their hospital visits throughout the two year randomised controlled trial.

The researchers report that the pharmacist’s calls may have also triggered more general discussion of the patient’s health and led to greater awareness and proactive attitudes towards health. Intervention group patients were also encouraged to discuss problems with healthcare teams at their hospital visits.

Discussing their study, the researchers say the results need to be replicated using a multicentre, randomised strategy and that this work is being done now.