What are patients' perceptions of Pharmacist home visits for people with moderate/severe COPD and multimorbidity, and does socioeconomic status impact their perception?

Problem

Chronic obstructive pulmonary disease (COPD) is a common chronic disease seen in primary care. A 29% increase in prevalence and hospitalisation is expected by 2034 which will have huge consequences on patient health, wellbeing, mortality and healthcare costs. A novel complex intervention has been developed to improve COPD management. It consists of repeated pharmacist home visits to patients with moderate-severe COPD with the aim of providing holistic care and medicines support in collaboration with the patients' consultant respiratory physician, GP and wider team. This intervention is being assessed by a pilot randomised controlled trial (RCT) in NHS GGC and NHS Lothian. This study aims: 1) to determine patient's perceptions of the intervention; 2) to explore if patient perception is influenced by their socioeconomic status. There is limited previous literature around this type of complex intervention and no studies have investigated patient perception or the role of socioeconomic status.

Approach

We undertook 8 semi structured interviews with a purposive sample of participants allocated to the intervention group in the pilot RCT described above; including 4 participants from areas of low deprivation and 4 participants from areas of high deprivation as determined by the Scottish Index of Multiple Deprivation (SIMD). The interview guide was informed by the concepts of Normalization Process Theory (NPT) to examine the acceptability and implementability of the pharmacist intervention. Interviews were conducted by phone, recorded and transcribed. Thematic analysis was used to qualitatively analyse and compare the interviews, the data is then being conceptualised through an NPT lens.

Findings

Participants were aged between 51 and 82; 4 were male and 4 were female; 4 lived within the most deprived SIMD quintile, one lived within the third and 3 lived in the least deprived. Preliminary analysis of the interviews suggests that the intervention has been well received. Our analysis indicates that patients from more deprived areas may have found the intervention more useful. Most participants from areas of high deprivation were very appreciative of the intervention, with one stating the pharmacist visits "enhanced everything" and were "very, very useful". Participants from areas of low deprivation appeared to view the pharmacist as an addition to their usual care, with one describing the pharmacist as a "third eye on the condition".

Consequences

Our findings may be used to inform intervention refinement and to support the case for this novel intervention to be assessed by a full scale RCT. The findings also further our understanding of the role socioeconomic status plays in the acceptability and reach of this type of complex intervention and may have implications for future targeting of such interventions.