***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE : To evaluate the effectiveness of a community pharmacist-based home blood pressure ( BP ) monitoring program . DESIGN : Trial of a high-intensity ( HI ) versus low-intensity ( LI ) intervention r and omized in 12 community pharmacies . The HI intervention comprised 4 face-to-face visits with a trained pharmacist . Pharmacists provided patient-specific education about hypertension . Following the first and third visits , patients were provided with a home BP monitoring device and instructed to measure their BP at least once daily for the next month . Home BP readings were used by the pharmacists to develop treatment recommendations for the patient ’s physician . Recommendations were discussed with the physician and , if approved , implemented by the pharmacist . In the LI intervention , pharmacists measured patients BP in the pharmacy and referred them to their physician for evaluation . PARTICIPANTS : Patients with uncontrolled BP at baseline . MEASUREMENTS : The main outcomes were the differences in systolic and diastolic BP ( SBP and DBP ) from baseline to follow-up between the HI and LI patients . RESULTS : The study enrolled 125 patients , 64 in the HI and 61 in the LI group . From baseline , SBP declined 13.4 mmHg in the HI group and 9.0 mmHg in the LI group . At the final visit , the difference in SBP/DBP change between the HI and LI group was −4.5/−3.2 mmHg ( P=.12 for SBP and P=.03 for DBP ) . CONCLUSIONS : The HI intervention achieved a lower DBP and this model could be a strategy for patients with hypertension The effect of pharmaceutical care on the prevention , detection , and resolution of medication-related problems in high-risk patients in a rural community was studied . Adult patients who received care at clinics in a medically underserved area of Alabama and who were identified as being at high risk of medication-related adverse events were r and omly assigned to a control group or an intervention group . The control group received st and ard medical care , and the intervention group received pharmaceutical care , including a medical record review , a medication history review , pharmacotherapeutic evaluation , and patient medication education and monitoring over a one-year period .  A total of 69 patients completed the study ( 33 in the intervention group and 36 in the control group ) . The percentage of patients responding to hypertension , diabetes , dyslipidemia , and anticoagulation therapy increased significantly in the intervention group and declined in the control group . Ratings for inappropriate prescribing improved in all 10 domains evaluated in the intervention group but worsened in 5 domains in the control group . There were no significant differences between the groups at 12 months in health-related quality of life or medication misadventures . Medication compliance scores improved in the intervention group but not in the control group . Medication knowledge increased in the intervention group and decreased in the control group . Pharmaceutical care in a rural , community-based setting appeared to reduce inappropriate prescribing , enhance disease management , and improve medication compliance and knowledge without adversely affecting health-related quality of life Background : A patient-centered approach is increasingly recognized as an important component in the evaluation of healthcare services . Objective : To assess patient satisfaction with , attitudes toward , and expectations of or experience with community pharmacy in genera ) , and to evaluate the effect of the community pharmacy – led medications management service on these factors . Methods : Postal question naire surveys were completed at baseline and after 12 months ( follow-up ) as part of a r and omized controlled trial of the service . The setting was 9 primary care organizations in Engl and . Patients with coronary heart disease were recruited from general practice registers and r and omly allocated to the intervention ( pharmacy-led medications management service ) or control group . Results : Survey response rates at baseline and follow-up were 88.4 % ( 1232/1394 ) and 80.1 % ( 1085/1355 ) , respectively . The respondents indicated that they wanted pharmacists to provide dispensing , medications review , advice on medications and health , private consultation areas , and short visit times . At follow-up , intervention patients were more likely than control patients ( p < 0.01 ) to rate the service provided by their pharmacist with a higher level of satisfaction , and most intervention patients stated a preference for seeing their physician to discuss their medications , although this was less marked than in control patients ( 76 % vs 85 % ; p < 0.01 ) . Intervention patients were also more willing than control patients to ask the pharmacist questions that they would be unable to ask a physician ( 20 % vs 11 % , respectively ; p < 0.01 ) , to ask the pharmacist questions about their medications ( 32 % vs 18 % , respectively ; p < 0.01 ) , and to recommend this practice to others ( 51 % vs 40 % , respectively ; p < 0.01 ) . Conclusions : Pharmacist intervention was associated with significant and positive changes in patient satisfaction . While patients probably continue to prefer a physician-led service , they value aspects of a pharmacy service . Patients generally preferred discussing medications with the family physician , but experiencing the community pharmacy-led service result ed in an attitudinal shift toward the pharmacist . These findings suggest a benefit in developing the community pharmacist 's role as a review er of , and adviser on , patients ' medications Objectives To explore differences in mean costs ( from a UK National Health Service perspective ) and effects of pharmacist-led management of chronic pain in primary care evaluated in a pilot r and omised controlled trial ( RCT ) , and to estimate optimal sample size for a definitive RCT . Design Regression analysis of costs and effects , using intention-to-treat and expected value of sample information analysis ( EVSI ) . Setting Six general practice s : Grampian ( 3 ) ; East Anglia ( 3 ) . Participants 125 patients with complete re source use and short form-six-dimension question naire ( SF-6D ) data at baseline , 3 months and 6 months . Interventions Patients were r and omised to either pharmacist medication review with face-to-face pharmacist prescribing or pharmacist medication review with feedback to general practitioner or treatment as usual ( TAU ) . Main outcome measures Differences in mean total costs and effects measured as quality -adjusted life years ( QALYs ) at 6 months and EVSI for sample size calculation . Results Unadjusted total mean costs per patient were £ 452 for prescribing ( SD : £ 466 ) , £ 570 for review ( SD : £ 527 ) and £ 668 for TAU ( SD : £ 1333 ) . After controlling for baseline costs , the adjusted mean cost differences per patient relative to TAU were £ 77 for prescribing ( 95 % CI −82 to 237 ) and £ 54 for review ( 95 % CI −103 to 212 ) . Unadjusted mean QALYs were 0.3213 for prescribing ( SD : 0.0659 ) , 0.3161 for review ( SD : 0.0684 ) and 0.3079 for TAU ( SD : 0.0606 ) . Relative to TAU , the adjusted mean differences were 0.0069 for prescribing ( 95 % CI −0.0091 to 0.0229 ) and 0.0097 for review ( 95 % CI −0.0054 to 0.0248 ) . The EVSI suggested the optimal future trial size was between 460 and 690 , and between 540 and 780 patients per arm using a threshold of £ 30 000 and £ 20 000 per QALY gained , respectively . Conclusions Compared with TAU , pharmacist-led interventions for chronic pain appear more costly and provide similar QALYs . However , these estimates are imprecise due to the small size of the pilot trial . The EVSI indicates that a larger trial is necessary to obtain more precise estimates of differences in mean effects and costs between treatment groups . Trial registration number IS RCT N06131530 OBJECTIVES Despite advances in recent years , asthma morbidity and mortality have been noted to be on the increase in the past decade . The present study examined the failures and recommendations of past studies and introduced a new milieu for asthma care -- the community pharmacy . The study incorporated a care protocol with the important ingredients of asthma education on medications , triggers , self-monitoring and an asthma plan , with pharmacists taking responsibility for outcomes , assessment of a patient 's readiness to change and tailoring education to that readiness , compliance monitoring and physician consultation to achieve asthma prescribing guidelines . METHODS Thirty-three pharmacists in British Columbia , specially trained and certified in asthma care , agreed to participate in a study in which experienced pharmacists would have asthma patients allocated to enhanced ( pharmaceutical ) care ( EC ) or usual care ( UC ) . Pharmacists less experienced were clustered by geography and had their pharmacies r and omized to two levels of care ; each pharmacy then had patients r and omized to EC versus control , UC versus control or EC versus UC depending on their pharmacy r and omization . Six hundred thirty-one patients provided consent , of which 225 in EC or UC were analyzed for all outcomes . Patients were followed for one year . RESULTS Compared with patients in the UC group , the results of those in the EC group were as follows : symptom scores decreased by 50 % ; peak flow readings increased by 11 % ; days off work or school were reduced by approximately 0.6 days/month ; use of inhaled beta-agonists was reduced by 50 % ; overall quality of life improved by 19 % , and the specific domains of activity limitations , symptoms and emotional function also improved ; initial knowledge scores doubled ; emergency room visits decreased by 75 % ; and medical visits decreased by 75 % . A patient satisfaction survey revealed that the population was extremely pleased with their pharmacy services . Cost analysis reinforces the EC model , which is more cost effective than UC in terms of most direct and indirect costs in asthma patients . CONCLUSION Specially trained community pharmacists in Canada , using a pharmaceutical care-based protocol , can produce impressive improvements in clinical , economic and humanistic outcome measures in asthma patients . The health care system needs to produce incentives for such care Background : Despite national disease management plans , optimal asthma management remains a challenge in Australia . Community pharmacists are ideally placed to implement new strategies that aim to ensure asthma care meets current st and ards of best practice . The impact of the Pharmacy Asthma Care Program ( PACP ) on asthma control was assessed using a multi-site r and omised intervention versus control repeated measures study design . Methods : Fifty Australian pharmacies were r and omised into two groups : intervention pharmacies  implemented the PACP ( an ongoing cycle of assessment , goal setting , monitoring and review )  to 191 patients over 6 months , while control pharmacies gave their usual care to 205 control patients . Both groups administered question naires and conducted spirometric testing at baseline and 6 months later . The main outcome measure was asthma severity/control status . Results : 186 of 205 control patients ( 91 % ) and 165 of 191 intervention patients ( 86 % ) completed the study . The intervention result ed in improved asthma control : patients receiving the intervention were 2.7 times more likely to improve from “ severe ” to “ not severe ” than control patients ( OR 2.68 , 95 % CI 1.64 to 4.37 ; p<0.001 ) . The intervention also result ed in improved adherence to preventer medication ( OR 1.89 , 95 % CI 1.08 to 3.30 ; p = 0.03 ) , decreased mean daily dose of reliever medication ( difference −149.11 μg , 95 % CI −283.87 to −14.36 ; p = 0.03 ) , a shift in medication profile from reliever only to a combination of preventer , reliever with or without long-acting β agonist ( OR 3.80 , 95 % CI 1.40 to 10.32 ; p = 0.01 ) and improved scores on risk of non-adherence ( difference −0.44 , 95 % CI −0.69 to −0.18 ; p = 0.04 ) , quality of life ( difference −0.23 , 95 % CI −0.46 to 0.00 ; p = 0.05 ) , asthma knowledge ( difference 1.18 , 95 % CI 0.73 to 1.63 ; p<0.01 ) and perceived control of asthma question naires ( difference −1.39 , 95 % CI −2.44 to −0.35 ; p<0.01 ) . No significant change in spirometric measures occurred in either group . Conclusions : A pharmacist-delivered asthma care programme based on national guidelines improves asthma control . The sustainability and implementation of the programme within the healthcare system remains to be investigated BACKGROUND Noncompliance is a major factor in the morbidity and unnecessary hospital readmissions for patients with heart failure . Several studies have aim ed to reduce rehospitalizations in heart failure patients through a comprehensive , multidisciplinary approach . Medication compliance was rarely measured in these studies or , when it was measured , the method employed was seldom valid . We aim ed at determining the effect of a pharmacist-led intervention on medication compliance in patients with heart failure . METHODS We conducted a r and omized controlled trial into the effect of a pharm 
    Output:
    
Services provided in community and primary care setting s were found to be either dominant or cost effective , at a £ 20,000 per quality -adjusted life-year threshold , compared with usual care .
Those delivered in the patient ’s home were not found to be cost effective .