Self medication is becoming an increasingly important area within healthcare. It moves patients towards greater independence in making decisions about management of minor illnesses, thereby promoting empowerment. Self medication also has advantages for healthcare systems as it facilitates better use of clinical skills, increases access to medication and may contribute to reducing prescribed drug costs associated with publicly funded health programmes. However, self medication is associated with risks such as misdiagnosis, use of excessive drug dosage, prolonged duration of use, drug interactions and polypharmacy. The latter may be particularly problematic in the elderly. Monitoring systems, a partnership between patients, physicians and pharmacists and the provision of education and information to all concerned on safe self medication, are proposed strategies for maximising benefit and minimising risk.

This study is the first large-scale, multicentre study to investigate the effects of pharmaceutical care provision by community pharmacists to elderly patients. Future research methodology and implementation will be informed by the experience gained from this challenging trial.

We evaluated a structured pharmaceutical care program for elderly patients (> 65 yrs) with congestive heart failure (CHF) based on objective measures of disease control, quality of life, and use of health care facilities in a randomized, controlled, longitudinal, prospective clinical trial. The 42 patients in group A received education from a pharmacist on the disease and its treatment, and lifestyle changes that could help control symptoms. Patients also were encouraged to monitor their symptoms and comply with prescribed drug therapy. If necessary, dosage regimens were simplified in liaison with hospital physicians. The 41 control patients (group B) received standard care. The following outcome measures were assessed in all patients at baseline (before the start of the trial) and at 3, 6, 9, and 12 months: 2-minute walk test, blood pressure, body weight, pulse, forced vital capacity, quality of life [disease-specific (Minnesota Living with Heart Failure questionnaire) and generic (SF-36)], knowledge of symptoms and drugs, compliance with therapy, and use of health care facilities (hospital admissions, visits to emergency room, emergency calls). Patients in group A showed improved compliance with drug therapy, which in turn improved their exercise capacity compared with those in group B; education on management of symptoms, lifestyle changes, and dietary recommendations were also of benefit. Group A patients significantly improved knowledge of their drug therapy over the 12-month study and had fewer hospital admissions compared with group B patients. They also had improved outcomes compared with group B, despite the small samples. An extension of this trial to other sites with pooling of results would provide additional evidence of the value of this structured program in elderly patients with CHF.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Pharmaceutical care programmes delivered by pharmacists are known to improve quality of care for both ambulatory and hospitalized patients with a variety of chronic and acute conditions. • Reduction of HbA1c and normalization of blood pressure are key targets for diabetes care programmes, since they are key to reducing diabetes complications.• Good knowledge about disease, medications, diet and exercise requirements can improve the effectiveness of self-management of diabetes. WHAT THIS STUDY ADDS• In a randomized, controlled clinical trial, a comprehensive pharmaceutical care programme (consisting of patient education and advice on medication adherence, metabolic control and life style) delivered by a clinical pharmacist over a 12-month period, significantly improved glycaemic control and health-related quality of life in Type 2 diabetes patients attending a military hospital outpatient clinic in the United Arab Emirates (UAE).• A significant reduction in HbA1c was important in the reduction of the 10-year coronary heart disease risk scores (by British National Formulary and Framingham methods) seen in patients who received the present care programme.• The outcomes of this study advocate an increased role for clinical pharmacists in the healthcare system in the UAE. AIMSTo examine the influence of a pharmaceutical care programme on disease control and health-related quality of life in Type 2 diabetes patients in the United Arab Emirates. METHODSA total of 240 Type 2 diabetes patients were recruited into a randomized, controlled, prospective clinical trial with a 12-month follow-up. A range of clinical measures, medication adherence and health-related quality of life (Short Form 36) were evaluated at baseline and up to 12 months. Intervention group patients received pharmaceutical care from a clinical pharmacist, whereas control group patients received their usual care from medical and nursing staff. The primary outcome measure was change in HbA 1c. British National Formulary and Framingham scoring methods were used to estimate changes in 10-year coronary heart disease risk scores in all patients. RESULTSA total of 234 patients completed the study. 85.2 mmHg (83.5, 86.8) vs. 76.3 mmHg (74.9, 77.7)] were observed in the intervention group; no significant changes were noted in the control group. The mean Framingham risk prediction score in the intervention group was 10.56% (9.7, 11.4) at baseline; this decreased to 7.7% (6.9, 8.5) (P < 0.001) at 12 months but remained unchanged in the control group. CONCLUSIONSThe pharmaceutical care programme resulted in better glycaemic control and reduced cardiovascular risk scores in Type 2 diabetes patients over a 12-month period.

AimThe aim of this study was to investigate the impact of a pharmacist-led pharmaceutical care programme, involving optimization of drug treatment and intensive education and self-monitoring of patients with heart failure (HF) within the United Arab Emirates (UAE), on a range of clinical and humanistic outcome measures. MethodsThe study was a randomized, controlled, longitudinal, prospective clinical trial at Al-Ain Hospital, Al-Ain, UAE. Patients were recruited from the general medical wards and from cardiology and medical outpatient clinics. HF patients who fulfilled the entrance criteria, and had no exclusion criteria present, were identified for inclusion in the study. After recruitment, patients were randomly assigned to one of two groups: intervention group or control group. Intervention patients received a structured pharmaceutical care service while control patients received traditional services. Patient follow-up took place when patients attended scheduled outpatient clinics (every 3 months). A total of 104 patients in each group completed the trial (12 months). The patients were generally suffering from mild to moderate HF (NYHA Class 1, 29.5%; Class 2, 50.5%; Class 3, 16%; and Class 4, 4%). ResultsOver the study period, intervention patients showed significant ( P < 0.05) improvements in a range of summary outcome measures [AUC (95% confidence limits)] including exercise tolerance [2-min walk test: 1607.2 (1474.9, 1739.5) m·month in intervention patients vs . 1403.3 (1256.5, 1549.8) in control patients], forced vital capacity [31.6 (30.8, 32.4) l·month in the intervention patients vs . 27.8 (26.8, 28.9) in control patients], health-related quality of life, as measured by the Minnesota living with heart failure questionnaire [463.5 (433.2, 493.9) unit·month in intervention patients vs . 637.5 (597.2, 677.7) in control patients; a lower score in this measure indicates better health-related quality of life]. The number of individual patients who reported adherence to prescribed medications was higher ( P < 0.05) in the intervention group (85 vs . 35), as was adherence to lifestyle advice (75 vs . 29) at the final assessment (12 months). There was a tendency to have a higher incidence of casualty department visits by intervention patients, but a lower rate of hospitalization. ConclusionsThe research provides clear evidence that the delivery of pharmaceutical care to patients with HF can lead to significant clinical and humanistic benefits.A. Sadik et al. 18460 :2 Br J Clin Pharmacol

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • The concept of self‐management plans for patients with chronic obstructive pulmonary disease (COPD) is derived from their success in asthma management. • It is believed that selected people with COPD may benefit from the early intervention that comes from following self‐management plans, which may prevent a crisis and possibly the need for hospital admission. • There is little published information on clinical pharmacist‐led disease and patient self‐management in the area of COPD care. WHAT THIS STUDY ADDS • A structured education programme led by a clinical pharmacist for patients with COPD was associated with a reduction in both hospitalization and emergency department visits and an improvement in patients' adherence to treatment regimens and health‐related quality of life (excluding physical activity). • The intervention programme was tailored and individualized based on a preliminary assessment of individual patient needs. • Education about self‐management in COPD patients should be explicit, tailored to individual needs, and on a continuous basis. AIM The aim was to investigate the impact of a disease and medicine management programme, focusing on self‐management in patients with chronic obstructive pulmonary disease (COPD). METHODS One hundred and seventy‐three patients (mean age 67 years; 54% female) were recruited; 86 patients were randomly assigned to an intervention group and 87 to a usual care (control) group. Intervention patients received education on disease state, medications and breathing techniques. Patients were given booklets and a customized action plan (antibiotic and oral steroid to be initiated promptly by patients for exacerbations). Patients were followed up at 6 and 12 months during a scheduled visit. The St George's Respiratory Questionnaire (SGRQ), COPD Knowledge and Morisky adherence questionnaires were administered to all patients at baseline, 6 and 12 months. Outcome measures included hospital admissions, emergency department (ED) visits, health‐related quality of life (HRQoL) and medication adherence. RESULTS Over the 12‐month period in the intervention group, ED visits decreased by 50% (P= 0.02) and hospitalization by approximately 60% (P= 0.01). On the SGRQ, differences reached statistical significance on the symptom (−7.5; P= 0.04) and impact (−7.4; P= 0.03) subscales but not on the physical activity subscale. There was a significant difference between the intervention and usual care groups regarding knowledge scores (75.0 vs. 59.3; P= 0.001) and good adherence to medication (77.8% vs. 60.0%, P= 0.019). There was no significant difference regarding smoking between study groups. CONCLUSIONS The clinical pharmacy‐led management programme can improve adherence, reduce the need for hospital care in patients with COPD and improve aspects of their HRQoL.

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A community-based pharmaceutical care program was appreciated by the participants and had a positive impact on the vitality of patients with asthma, inhaler technique, and PEE.