Figure 1 : Study areas

1. Improving outcomes and quality of life for people on methadone maintenance therapy (MMT): the enhanced pharmacy services (EPS) randomised controlled trialM Jaffray1, C Matheson1, CM Bond1, AJ Lee1, A Johnstone2, B Davidson3, L Skea31 Centre of Academic Primary Care, University of Aberdeen, 2 STRADA, 3 NHS Grampian • Background: Most (79%) Scottish pharmacies dispense methadone to over 17,000 patients1 over half of whom (57%) consume methadone daily under pharmacist supervision. Consequently there is considerable contact between pharmacists and methadone patients1 and pharmacists see methadone patients more frequently than other health care professionals. Our pilot study2 demonstrated the feasibility of the provision of enhanced pharmacy services (EPS) by pharmacists using motivational interviewing (MI) techniques. This RCT was to determine the effectiveness of such a service. • Aim and objectives: • Aim: To identify whether pharmacists trained in MI techniques, enabling them to provide EPS for patients on MMT, could improve patient treatment outcomes. • Specific objectives were to: • Train pharmacists to provide EPS for methadone patients through providing training in MI; • Measure whether the outcomes of MMT vary in patients receiving EPS compared to standard care; • Measure treatment satisfaction for patients receiving EPS compared to those receiving standard care; • Explore whether pharmacists trained to provide EPS demonstrate a change in attitude towards drugs misusers and their belief in ‘self-efficacy’. • Methods: • Study design: This was a cluster RCT with randomisation by pharmacy. Control pharmacies provided standard care and intervention pharmacists were trained in the basic principles and practice of MI. • Subjects and setting: Patients receiving daily supervised methadone (started in the previous 9 months) who were over 18 years old were eligible for inclusion. All pharmacies providing MMT for >10 patients were invited to take part. • Data collection: At baseline and at 6 months, structured interviews (using the Maudsley Addiction Profile3 and Treatment satisfaction questionnaire) were conducted with patients. Postal questionnaires were sent to pharmacists (questions included 5 point Likert scales to measure agreement with attitude statements and belief in ‘self efficacy’). • Primary outcome : illicit use of heroin. • Secondary outcomes: retention in treatment, injecting behaviour and risky injecting practice, physical and psychological health and treatment satisfaction. • Ethical Approval: The study was granted Research Ethical approval from MREC and R&D in all six study sites. • Results: • Recruitment: Seventy-seven pharmacists and 542 patients (295 intervention, 247 control) participated from six study areas (Figure 1). Patient demographics are summarised in Figure 2. Figure 1: Study areas • Key: • 1.Grampian • 2. Tayside • 3. Forth Valley • 4. Lanarkshire • 5. Ayrshire • 6. Fife 1 2 3 6 4 5 Figure 2: Participant demographics • Main outcomes: Significant changes were seen in the intervention group (Table 1). These were: • A decrease in physical health; • A decrease in psychological health; • An increase in treatment satisfaction. Table 1: Main Outcomes Conclusion: MI based EPS for methadone patients improved satisfaction and retention but did not significantly improve clinical outcomes such as heroin use. Poorer physical and psychological health in the intervention patients may be due to chance or reflect increased patient awareness of their health as a result of the intervention. References: 1. Matheson C., Bond CM., Tinelli M. (2006) Community Pharmacy Services for drug misusers: measuring national service delivery and the development of professional attitudes and practice over a decade. CSO report. 2. Matheson et al (2006) Enhanced Community Pharmacy Activities for methadone. Report to the CSO: CZG/2/197. Scottish Executive. 3. Marsden, J. Gossop, M. Stewart, D. Best, D. Farrell, M. Lehmann, P. Edwards, C. & Strang, J. (1998) The Maudsley Addiction Profile (MAP): A brief instrument for assessing treatment outcome. Addiction 93(12): 1857-1867. This study was funded by the CSO