critical apprasial
Critical appraisal
Holland R et al
Effectiveness of visits from community pharmacists for patients with heart failure: HeartMed randomised controlled trial http://www.bmj.com/cgi/reprint_abr/334/7603/1098 AIM
The aim was to see if community pharmacists can reduce re-admission to hospital for patients known to have heart failure. Heart failure is a common and serious illness so this is a worthwhile research topic.
SETTING AND EXCLUSIONS
The setting is stated as three large district general hospitals, not specified. The authors are from Norwich; if in fact this study was conducted locally it may well not apply to metropolitan areas where the quality and structure of primary care is very different.
Adults in whom 'heart failure was an important ongoing clinical condition' were included. This is a strikingly loose definition, which the authors defend as 'pragmatic'. The other requirement – two or more drugs – does however help to reduce some of the imprecision in case definition.
People in residential care were excluded by design. This effect of this exclusion is not estimated by the authors. People in residential care have more illness than those living at home but it is difficult to know whether they form a large proportion of those with heart failure in a population. The other exclusions are minor.
In the end, the authors randomised 339 of 555 eligible patients, and studied 293, well under 60% of the study population. This raises the serious possibility of bias (discussed below).
INTERVENTION - design
The intervention was designed as a home medication and lifestyle review by trained community pharmacists soon after discharge from hospital. The training included lifestyle advice (diet, exercise, smoking) but is only stated to include lectures. Lifestyle training should include social learning, role play and other techniques, not just didactic.
The home visit was manualised which should help to standardise the intervention.
Holland R et al
Effectiveness of visits from community pharmacists for patients with heart failure: HeartMed randomised controlled trial http://www.bmj.com/cgi/reprint_abr/334/7603/1098 AIM
The aim was to see if community pharmacists can reduce re-admission to hospital for patients known to have heart failure. Heart failure is a common and serious illness so this is a worthwhile research topic.
SETTING AND EXCLUSIONS
The setting is stated as three large district general hospitals, not specified. The authors are from Norwich; if in fact this study was conducted locally it may well not apply to metropolitan areas where the quality and structure of primary care is very different.
Adults in whom 'heart failure was an important ongoing clinical condition' were included. This is a strikingly loose definition, which the authors defend as 'pragmatic'. The other requirement – two or more drugs – does however help to reduce some of the imprecision in case definition.
People in residential care were excluded by design. This effect of this exclusion is not estimated by the authors. People in residential care have more illness than those living at home but it is difficult to know whether they form a large proportion of those with heart failure in a population. The other exclusions are minor.
In the end, the authors randomised 339 of 555 eligible patients, and studied 293, well under 60% of the study population. This raises the serious possibility of bias (discussed below).
INTERVENTION - design
The intervention was designed as a home medication and lifestyle review by trained community pharmacists soon after discharge from hospital. The training included lifestyle advice (diet, exercise, smoking) but is only stated to include lectures. Lifestyle training should include social learning, role play and other techniques, not just didactic.
The home visit was manualised which should help to standardise the intervention.