Supporting adherence for people starting a new medication for a long-term condition through community pharmacies: a pragmatic randomised controlled trial of the New Medicine Service

Rachel Ann Elliott, Matthew J Boyd, Nde-Eshimuni Salema, James Davies, Nicholas Barber, Rajnikant Laxmishanker Mehta, Lukasz Tanajewski, Justin Waring, Asam Latif, Georgios Gkountouras, A J Avery, Antony Chuter, Christopher Craig

Research output: Contribution to journalArticlepeer-review

43 Citations (Scopus)


OBJECTIVE: To examine the effectiveness of the New Medicine Service (NMS), a national community pharmacy service to support medicines-taking in people starting a new medicine for a long-term condition, compared with normal practice.

METHODS: Pragmatic patient-level parallel randomised controlled trial, in 46 community pharmacies in England. Patients 1:1 block randomisation stratified by drug/disease group within each pharmacy. 504 participants (NMS: 251) aged 14 years and over, identified in the pharmacy on presentation of a prescription for asthma/chronic obstructive pulmonary disease, hypertension, type 2 diabetes or an anticoagulant/antiplatelet agent. NMS intervention: One consultation 7-14 days after presentation of prescription followed by another 14-21 days thereafter to identify problems with treatment and provide support if needed. Controls received normal practice. Adherence, defined as missing no doses without the advice of a medical professional in the previous 7 days, was assessed through patient self-report at 10 weeks. Intention-to-treat analysis was employed, with outcome adjusted for recruiting pharmacy, NMS disease category, age, sex and medication count. Cost to the National Health Service (NHS) was collected.

RESULTS: At 10 weeks, 53 patients had withdrawn and 443 (85%) patients were contacted successfully by telephone. In the unadjusted analysis of 378 patients still taking the initial medicine, 61% (95% CI 54% to 67%) and 71% (95% CI 64% to 77%) patients were adherent in the normal practice and NMS arms, respectively (p=0.04 for difference). In the adjusted intention-to-treat analysis, the OR for increased adherence was 1.67 (95% CI 1.06 to 2.62; p=0.027) in favour of the NMS arm. There was a general trend to reduced NHS costs, albeit, statistically non-significant, for the NMS intervention: saving £21 (95% CI -£59 to £100, p=0.128) per patient.

CONCLUSIONS: The NMS significantly increased the proportion of patients adhering to their new medicine by about 10%, compared with normal practice.

TRIAL REGISTRATION NUMBERS: trial reference number NCT01635361 ( Current Controlled trials: trial reference number ISRCTN 23560818 (; DOI 10.1186/ISRCTN23560818). UK Clinical Research Network (UKCRN) study 12494 (

Original languageEnglish
Pages (from-to)747-58
Number of pages12
JournalBMJ Quality & Safety
Issue number10
Early online date8 Dec 2015
Publication statusPublished - Oct 2016


  • Adult
  • Aged
  • Chronic Disease/drug therapy
  • Community Pharmacy Services/economics
  • Cost-Benefit Analysis
  • England
  • Female
  • Health Knowledge, Attitudes, Practice
  • Health Status
  • Humans
  • Male
  • Medication Adherence/statistics & numerical data
  • Middle Aged
  • Pharmacists
  • Professional Role
  • State Medicine/economics


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