Clinical significance of clinical interventions in community pharmacy: A randomised trial of the effect of education and a professional allowance

Objectives: To assess the clinical significance of clinical interventions undertaken by community pharmacists, and to explore the effect of providing education and/or remuneration on the clinical significance of interventions. Design: Randomised trial involving four groups of community pharmacists; expert panel to assess the clinical significance of the interventions. Methods: The "proactive" clinical interventions undertaken by community pharmacists during the trial were reviewed by an expert panel for assessment of avoided adverse health consequences and clinical significance. The panel used a validated assessment instrument developed from the existing research literature and a pilot study by the authors. Data analysis: Agreement between experts was determined using the kappa statistic. In addition, the results of the expert panel were analysed for cases where the majority of experts provided the same assessment of clinical significance (ie, consensus). Results: Overall, there was no statistically significant difference in the clinical significance of clinical interventions undertaken by the four study groups. However, there were significant differences (95% CI) in the types of proactive interventions undertaken, with the two groups that received an educational intervention being more likely to engage in more complex intervention areas, such as drug/drug interactions and adverse/side effects. Analysis of consensus revealed that 52% of proactive clinical interventions were deemed to be "clinically significant" and 2% were deemed to be either "clinically very significant" or "potentially life-saving". When extrapolated to national Australian prescribing figures, a mean of 3,752 potentially life-saving interventions by community pharmacists could be expected per year (95% CI 454 to 13,554). Conclusion: The results of this study provide the first estimates of the potential clinical benefits associated with clinical interventions in Australian community pharmacies. The study contributes evidence on the value of pharmaceutical services to the health care system. As such, it is expected that the study findings will provide a platform for discussion and decision-making.