A cluster randomised controlled trial of enhanced pharmacy services (EPS) to improve outcomes for patients on methadone maintenance therapy (MMT)

First published: 10/05/2019 | Last updated: May 20th, 2019

Aims: To identify whether pharmacists trained in motivational interviewing (MI)  techniques, providing EPS for patients on MMT, can improve patient outcomes.

Design: A cluster RCT, randomised by pharmacy.

Setting: Seventy-six community pharmacies, providing MMT to at least 10 daily clients, from six Scottish NHS areas.

Participants: Patients >18 years, recently started on MMT (in last 9 months) taken under pharmacist supervision in community pharmacy; associated pharmacists.

Intervention: Intervention pharmacists trained in MI techniques.  Controls delivered standard care.

Measurements: Primary outcome was illicit heroin use. Other measures included: treatment retention, substance use, injecting behaviour, psychological and physical health treatment satisfaction. Data was collected via structured interviews at baseline and six months.

Findings: 542 patients (295 intervention, 247 control) participated: mean age 32 years;  64% male; 91% unemployed; mean treatment length nine months.

At follow-up, within group differences were: illicit heroin use: intervention reduced (88% to 59%, p<0.001), control reduced (77% to 48%, p<0.001); retention in treatment higher in intervention group only (88% cf 81%; p=0.34); treatment satisfaction score improved significantly in the intervention group (p<0.05) but not in controls (p=0.26). By follow-up, psychological and physical health had deteriorated among intervention patients whose physical health was poorer compared to controls (both p<0.05).

Conclusions: 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 intervention patients may be due to chance or reflect increased patient awareness of their health as a result of the intervention.

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Dr Mariesha Jaffray